Preventing osteoporosis: the new significance of hyperparathyroidism.

Although a cautious approach is essential, there is still no safe and effective chronic medical therapeutic regimen that can substitute for surgical management of primary hyperparathyroidism in the elderly. The primary care physician should recognize that: the natural history of this disease is variable and unpredictable; symptomatic disease in the elderly patient may be easily overlooked; and therefore, older patients who have vague and varied nonspecific neuromuscular, GI, and constitutional complaints or acquired behavior disturbances should be carefully scrutinized. This approach to hyperparathyroidism should lead to earlier diagnosis and symptomatic relief in many patients who would otherwise be viewed as merely "old" or as chronic complainers.