MICROANATOMY

Detailed explanation-1: -The committee agreed that bisphosphonates should be considered in people with primary hyperparathyroidism and bone end organ effects, to reduce fracture risk in line with NICE guideline on osteoporosis: assessing the risk of fragility fracture.

Detailed explanation-2: -Although bisphosphonates are most commonly used to treat established hypercalcemia, they have also been given to prevent hypercalcemia and adverse skeletal events, particularly in patients with metastatic cancer to bone.

Detailed explanation-3: -Cinacalcet is the drug of choice for managing hypercalcemia, whereas bisphosphonates or denosumab improves BMD. Combined therapy with cinacalcet and a bisphosphonate or cinacalcet and denosumab should be considered if the effects on serum calcium and BMD are simultaneously desired.

Detailed explanation-4: -Bisphosphonates inhibit osteoclastic bone resorption and are effective in the treatment of hypercalcemia due to conditions causing increased bone resorption and malignancy-related hypercalcemia. Pamidronate and etidronate can be given intravenously, while risedronate and alendronate may be effective as oral therapy.