Abstract
<h3>In reply</h3> Anand and Anand raised some interesting questions about the treatment of cancer-associated hypercalcemia. The role of parathyroid hormone—related protein (PTHrP) in cancer-associated hypercalcemia is the focus of intense research. Many studies<sup>1-4</sup>suggest that increased PTHrP levels negatively influence the response of hypercalcemia to bisphosphonates. Walls et al<sup>4</sup>reported that circulating PTHrP significantly reduced the effectiveness of pamidronate in patients with no bone metastases. However, in two randomized, prospective, double-blind studies<sup>5,6</sup>of cancer-associated hypercalcemia, we demonstrated that the efficacy of pamidronate therapy was similar in patients with and without bone metastases. Some studies<sup>3</sup>have shown a positive correlation between increased PTHrP concentrations and corrected serum calcium levels, but others<sup>1,2</sup>have not confirmed this. Many different PTHrP detection methods are currently in use.<sup>7,8</sup>This makes it difficult to compare the relative role of PTHrP in published studies. Additionally, the prediction of a poor response
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