There is an extensive list of possible diagnoses for hypercalcemia, but a workable approach is to consider parathyroid versus nonparathyroid disease.

Intact parathyroid hormone laboratory assay is used to differentiate hyperparathyroidism from other disorders.

Most patients with hyperparathyroidism have chronic asymptomatic hypercalcemia.

Surgery is the treatment of choice for primary hyperparathyroidism.

Osteomalacia is the hallmark of poor skeletal mineralization due to hypocalcemia, hypophosphatemia, or both.

Primary findings in osteomalacia include hypocalcemia, hypophosphatemia, and hyperphosphatasia.

The phosphorus level helps to differentiate the cause of hypocalcemia.

Vitamin D deficiency is commonplace and can be due to sunlight deprivation, inadequate dietary sources, malabsorption, and/or increased catabolism.

Primary hypoparathyroidism is a very rare phenomenon, and primary disease generally arises early in life.

Patients who have undergone bariatric surgery are at risk for vitamin D deficiency, secondary hyperparathyroidism, and osteomalacia.

Over 2 million fractures occur in the United States every year with approximately 300,000 hip fractures. Mortality with hip fracture is higher than 20%.

Osteoporosis remains a clinical diagnosis, with reliance on the medical history, assessment of risk factors, and bone densitometry (DXA).

FRAX® is a computer-based tool that uses common risk factors to calculate the 10-year probability of fracture, and was developed to assist the clinician identify patients who are most likely to benefit from medical therapy.

DXA and FRAX have limited utility in the obese and bariatric surgery patient in that neither can quantify bone quality.

Treatment for primary osteoporosis includes calcium and vitamin D, exercise, and medications.

Osteonecrosis of the jaw is a very rare occurrence related to the use of bisphosphonates and is typically treated conservatively with antibiotics and oral rinses.

When considering medical interventions in men with osteoporosis, a thorough investigation for possible secondary causes is essential, and any underlying secondary cause should be the first priority in the treatment plan.

The decision regarding a drug holiday from osteoporosis agents needs to carefully balance risks versus benefits of continued treatment.