What is the recommended treatment for paraneoplastic hypercalcemia?

Paraneoplastic hypercalcemia is often associated with malignancies, particularly those that lead to the release of parathyroid hormone-related peptide (PTHrP), which causes increased bone resorption and calcium release into the bloodstream. The use of osteoclast inhibitors, such as bisphosphonates or denosumab, is the recommended treatment for managing the elevated calcium levels in this condition. These medications work by inhibiting osteoclast activity, which helps to reduce bone resorption and, consequently, lower serum calcium levels.

While surgical removal of the tumor is a definitive treatment for certain solid tumors that may cause hypercalcemia, it is not always feasible or immediately possible, particularly in cases where the malignancy is widespread or inoperable. Diuretics can aid in the management of hypercalcemia-related symptoms but do not address the underlying cause or decrease the serum calcium directly. Chemotherapy may be indicated for some cancers but is not a primary treatment for managing hypercalcemia. Therefore, the use of osteoclast inhibitors is the most effective and immediate approach to treating paraneoplastic hypercalcemia.