For long-term control of hypercalcemia in immobilization, which medication is commonly considered?

• A. Bisphosphonates
• B. Calcitonin
• C. Loop diuretics
• D. Steroids

Answer: (A)

Immobilization causes hypercalcemia mainly because lack of mechanical loading increases osteoclast activity and bone resorption, releasing calcium into the blood. To achieve long-term control, you want to suppress that bone turnover. Bisphosphonates fit this role by binding to bone and inhibiting osteoclasts, which reduces bone resorption and lowers calcium levels over time. They have a durable effect and are commonly used for sustained management of immobilization-related hypercalcemia. Calcitonin can lower calcium quickly but its effect wanes with time, making it better for short-term relief. Loop diuretics may raise calcium loss in the urine but don’t address the underlying bone remodeling and aren’t ideal for long-term control. Steroids are useful in other forms of hypercalcemia (like vitamin D–mediated causes) but not typically for immobilization. So the best choice for long-term control is bisphosphonates.