Treatment of hypercalcaemia

Bendroflumethiazide acts to reduce renal calcium excretion and is likely therefore to further elevate the serum calcium level. Whilst bisphosphonates may be used to help lower serum calcium levels in the short term, their use in the longer term should be reserved for those in whom surgery is not possible. In addition, in this case the patient has only mild osteopenia at a single site, and this is likely to respond to correction of the hyperparathyroidism. Although long-term surveillance in clinically asymptomatic subjects has previously been favoured by some clinicians, this approach is no longer recommended in patients who are suitable for surgery, especially when there is evidence of associated complications (eg nephrolithiasis, osteopenia/
osteoporosis, hypertension). Low-calcium diets are not appropriate, and indeed may exacerbate associated bone disease.