A 60-year-old woman presents with recurrent kidney stones and fatigue for the past year. | Medibuddy
2nd May 2024

A 60-year-old woman presents with recurrent kidney stones and fatigue for the past year.

A 60-year-old woman presents with recurrent kidney stones and fatigue for the past year. She also reports a recent history of bone pain and constipation. Her medical history is significant for hypertension, which is currently managed with a thiazide diuretic. On examination, she appears lethargic and dehydrated.

Investigations:

Serum Calcium: 2.75 mmol/L (2.2–2.6)

Serum Phosphate: 0.8 mmol/L (0.8–1.5)

Serum Creatinine: 90 µmol/L (45–84)

Serum PTH: Elevated

24-hour urinary calcium: 450 mg/day

Bone mineral density (BMD) T-score: -2.6 at the lumbar spine

 

Which is the most appropriate initial treatment?

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