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1. Hydration - 3-4 liters if no contraindications.

2. Bisphosphonates interfere with bone resorption in areas of high turnover (malignancy) and are used in conjunction with saline infusions and calcitonin.

3. Pamidronate and zoledronic acid are representative drugs, favored because of their rapid onset of action & IV formulation.

4. These drugs are associated with osteonecrosis of the jaw in patients with multiple myeloma and metastatic bone disease.

5. Give glucocorticoids for sarcoidosis and myeloma.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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