USE: Management of hypercalcemia.

MECH: Hypercalcemia leads to dehydration so first line treatment is volume expansion (4-6 L in 24hrs). Also dilutes intravascular Calcium to appropriate levels.

USE: Severe cases of hypercalcemia. Increases calcium excretion by inhibiting reabsorption of sodium in TAL thus inhibiting passive reabsorption of calcium downstream.

CAUTION: Don't use until volume status has been restored!

GEN: Bisphosphonate. Poorly absorbed in intestine, must be given IV.

MECH: Inhibit osteoclastic bone resorption and can impair mineralization of newly forming bone.

USE: Hypercalcemia of malignancy. One time infusion over 2-4 hours.

AE: Fever and flu-like symptoms.

GEN: Bisphosphonate. Poorly absorbed in intestine, must be given IV.

MECH: Inhibit osteoclastic bone resorption and can impair mineralization of newly forming bone.

USE: Hypercalcemia of malignancy. One time infusion over 15 mins.

AE: Fever and flu-like symptoms.

GEN: Nasal spray of salmon calcitonin

MECH: Increases calcium excretion. Inhibits osteoclast bone resorption.

USE: HYPERCALCEMIA TREATMENT in acute setting--overuse can cause tachyphylaxis in 2-3 days! Nasal spray is taken at home--effects disputed. Has an analgesic effect on vertebral fractures.

AE: Rhinitis.

USE: May be useful in lowering calcium in patients with Vit. D intoxication, granulomatous disease, and hematologic malignancies.

MECH: Decrease production of 1,25 dihydroxyvitamin D.

GEN: Bisphosphonate. Oral.

MECH: Inhibit osteoclastic bone resorption resulting in increase in BMD with a decrease in bone turnover markers and fracture risk.

USE: Osteoporosis.

AE: Esophageal irritation.

CAUTION: Must NOT be deficient in vitamin D. Must be taken fasting with a full glass of water. Patient must remain upright for 30 minutes and not take any meds with it.

GEN: Bisphosphonate. Oral.

MECH: Inhibit osteoclastic bone resorption resulting in increase in BMD with a decrease in bone turnover markers and fracture risk.

USE: Osteoporosis.

AE: Esophageal irritation.

CAUTION: Must NOT be deficient in vitamin D. Must be taken fasting with a full glass of water. Patient must remain upright for 30 minutes and not take any meds with it.

GEN: Bisphosphonate. Oral.

MECH: Inhibit osteoclastic bone resorption resulting in increase in BMD with a decrease in bone turnover markers and fracture risk.

USE: Osteoporosis.

AE: Esophageal irritation.

CAUTION: Must NOT be deficient in vitamin D. Must be taken fasting with a full glass of water. Patient must remain upright for 30 minutes and not take any meds with it.

GEN: Selective estrogen receptor modulator (SERM).

MECH: Estrogen-like compound which decreases bone resorption without increasing risk of breast cancer.

USE: For post-menopausal women.

AE: Hot flash exacerbation, increased risk of DVT.

GEN: PTH analog.

USE: Patients who have failed other therapies and are at risk of fracture. Daily subcue injections for up to 2 years.

MECH: Stimulates bone resorption and formation (favors formation). Net effect is increased BMD and decr. in fractures.

AE: Mild hypercalcemia, maybe an osteosarcoma risk (seen in murine model).

CAUTIONS: Not for people at risk of osteosarcoma such as patients with Paget's disease or those who have had radiation.

MECH: RANK Ligand inhibitor, antiresorptive agent.

CONTRA: Hypocalcemia.

AE: Slight increase in infection risk.