The treatment of calcification largely depends on the cause and the location where the accumulation of calcium has occurred as well as the complications that arise as a result of the disorder. The management of calcification due to hypercalcemia is primarily focused on the severity of the hypercalcemia and associated symptoms.
These patients are managed with IV hydration, bisphonates, calcitonin, prednisone, gallium nitrate, and hemodialysis; however, patients with hypercalcemia of malignancy generally have a poor prognosis. Thus, most care given is palliative.
Cutaneous manifestations of calcification have very limited therapy and the underlying problem should be corrected in order to effectively manage them. Nonetheless, agents such as corticosteroids may be used, since these tend to have great anti-inflammatory properties and inhibit fibroblastic activity, which is associated with the skin deposits.
Myo-inositol hexaphosponate has been shown to inhibit calcium salt crystallization and may have some benefit in patients with cutaneous calcium deposition.
Moreover, the calcium channel blocker diltiazem also has shown to have varying beneficial results. In addition to a chemotherapeutical approach, physical (e.g. electric shock wave lithotripsy) and surgical therapy may also be used against cutaneous calcification.
Vascular and Breast Calcification Therapies
Vascular calcification is a valuable predicator of the development of coronary heart disease. Lipid-lowering drugs are effective in reducing the progression of coronary and vascular calcification. Additionally, therapies for osteoporosis such as calcitriol, calcium supplements, estradiol, and intermittent PTH are proposed to have varying effects on vascular calcification.
Intermittent PTH has shown to suppress vascular calcification without any changes to serum phosphorous, which is the opposite to what occurs with continuous PTH in hyperparathyroidism.
However, the many agents used for the treatment of cardiovascular disease such as hormone replacement therapy, antioxidants, statins, and angiotensin-converting enzyme inhibitors may affect bone health.
Breast calcifications are handled on the basis of neoplastic (cancerous) suspicion. Deposits that are benign are considered to be harmless and no treatment or further evaluation is needed. Those that are probably benign typically have a less than 2% chance of neoplastic potential, but they are generally monitored yearly with mammograms (breast X-rays).
Calcifications that are suspicious need to be biopsied and examined for malignant potential. If found to be cancerous, treatment may involve surgery and chemo and/ or radiotherapy.
Management of Calcifying Tendinitis and Joints
Calcifying tendinitis treatment varies based on the radiological and clinical phase of the calcification. Patients may be given analgesics such as NSAIDs to reduce pain associated with the condition. Physical therapy is generally indicated to ensure maintenance or regaining of joint range and motion. Forms of physical therapy include heat, ice therapy, and electro-analgesia.
Although the mechanism of action is unknown, extracorporeal shock wave therapy is believed to cause mechanical breakdown of the deposit in collaboration with tissue absorption.
Other means of causing mechanical disintegration of the calcium deposits include puncturing them with needles and aspirating their contents. Radiation therapy may also be employed for calcifying tendinitis.
Surgical means of removing the deposits may be done with an arthroscopic (needle aspirated under ultrasound guidance) or open (curetted out deposits) procedure, with the former having a better cosmetic and rehabilitation outcome.
Reviewed by Susha Cheriyedath, MSc