<prompt> Answer this question truthfullyWhat is the medical treatment for hyperparathyroidism?  <response>: <reason> Medical therapy for hyperparathyroidism should be considered in the following circumstances: Patients with hyperparathyroidism not meeting the guidelines for surgery. Patients with hyperparathyroidism having contraindications to surgery. Patient with hyperparathyroidism who have previous unsuccessful neck exploration. Patient with hyperparathyroidism who have not been cured by surgery. Patient with hyperparathyroidism refuses surgery.1. Primary hyperparathyroidism 1.1 Nutritional supplementation 1.1.1 Low calcium intake Preferred regimen 1: Elemental calcium 500 mg PO q24h Note: Dietary calcium restriction is not necessary in primary hyperparathyroidism. 1.1.2 Vitamin D depletion Preferred regimen 1: Cholecalciferol 6001000 IU PO q24h Note1: Vitamin D deficiency is considered when serum level of 25-hydroxy vitamin D is below 50 nM 20 ngmL. Note2: Serum calcium levels and urinary calcium excretion should be monitored during vitamin D supplementation. Vitamin D supplementation should be stopped if serum calcium levels is 11.6 mgdL andor urinary calcium excretion is 400 mg24 h. Note3: The goal of vitamin D supplementation is to keep 25-hydroxy vitamin D level between 50 nmolL to 75 nmolL. 1.2 Pharmacotherapy 1.2.1 Bisphosphonates Preferred regimen 1: Alendronate 10 mg PO q24h 1.2.2 Calcimimetics Preferred regimen 1: Cinacalcet HCl 30-120 mg PO q12h Note1: Cinacalcet may be used in patients with familial primary hyperparathyroidism as a treatment option for patients having recurrent or persistent hypercalcemia after parathyroidectomy. Note2: A combination of bisphosphonates and calcimimetics may be used to reduce the serum calcium and improve bone mineral density. 1.2.3 Estrogen receptor -targeted therapy post-menopausal women Preferred regimen 1: Conjugated equine estrogen 0.625 mg q24h medroxyprogesterone acetate 5mg q24h Note1: The risk-benefit ratio should be assessed with respect to known relative or absolute contraindication to use of estrogen in each patient. 2. Secondary hyperparathyroidism 2.1 Secondary hyperparathyroidism due to vitamin D deficiency 2.1.1 Vitamin D analogs Preferred regimen 1: Calcitriol Preferred regimen 2: Paricalcitol Preferred regimen 3: Doxercalciferol 2.2 Secondary hyperparathyroidism due to Chronic renal failure 2.2.1 Vitamin D analogs Preferred regimen 1: Calcitriol 0.5 μg thrice weekly Preferred regimen 2: Paricalcitol 2 μg thrice weekly Preferred regimen 3: Doxercalciferol 1 μg thrice weekly 2.2.2 Phosphate binders phosphate restriction 2.2.3 Calcimimetics Preferred regimen 1: Cinacalcet HCL 30-180 mg PO q24h 3. Tertiary hyperparathyroidism 3.1 Calcimimetic drugs Preferred regimen 1: Cinacalcet HCL 