HYPERCALCEMIA AND BONE-RESORPTION IN MALIGNANCY

Hypercalcemia is the most common paraneoplastic syndrome associated wi th cancer. This paper addresses the etiology and pathogenesis of hyper calcemia of malignancy and discusses the relative contributions of loc al and humoral effects on bone and renal calcium homeostasis. The role s of parathyroid hormone-related protein and other osteolytic cytokine s are outlined. New biochemical markers that enable more specific moni toring of the response of bone metastases to treatment are introduced, including urinary excretion of the collagen crosslinks pyridinoline a nd deoxypyridinoline. The clinical management and prevention of hyperc alcemia is systemically outlined, including indications for bisphospho nate, glucocorticoid, and calcitonin therapy. The results of recent tr ials of bisphosphonate therapy for the prevention of tumor progression and its subsequent problems such as bone pain, fracture, and hypercal cemia also are discussed.