Cinacalcet, a calcimimetic, is approved for specific indications in PHPT by the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA). The EMA approved the use of cinacalcet for patients with hypercalcemia who meet surgical criteria but in whom parathyroidectomy is not possible or not clinically “appropriate.” The FDA approval is for severe hypercalcemia in patients with PHPT who are unable to undergo parathyroidectomy. Adverse effects of cinacalcet include nausea, vomiting, diarrhea, and headache, but are uncommon when the single 30-mg daily dose is used [4].
Alendronate, a bisphosphonate, improved BMD in patients with PHP. In patients who require both a reduction in serum calcium levels and an improvement in BMD, combination therapy with cinacalcet and alendronate is reasonable, but has only been studied in a retrospective manner [4].
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