Modern Treatment Options of Secondary Hyperparathyroidism in the Context of Cardiovascular Calcification.

Untreated secondary hyperparathyroidism (sHPT) has deleterious effects on various organ systems. In recent years, cardiovascular calcification as a result of sHPT-associated alterations in bone and mineral metabolism and therapeutic interventions used for its treatment has become the focus of research and treatment concepts. All the therapies used have proven to be effective in terms of correction of the laboratory changes of sHPT, but only very few have also been evaluated clinically in their effect on cardiovascular calcification and patient-related outcome data (mortality, cardiovascular morbidity). Whereas there are insufficient high-quality randomized controlled trials in the field, this shortcoming should not lead to a nihilistic approach to the relevant clinical problems of patients with sHPT. Nevertheless, because of insufficient clinical data, a single treatment modality, be it phosphorus binders, vitamin D substitution with inactive forms or calcitriol (or vitamin D analogue), calcimimetic, or parathyroidectomy, may not claim to be uniformly superior to the others. A wider therapeutic window often prompts the use of a combination of these options and individualization of sHPT management.