Serum bone GLA-protein, a modem and sensitive marker of bone turnover, was measured in 15 patients with primary hyperparathyroidism, 18 patients with hypercalcemia of malignancy, 41 patients with bone metastasis without hypercalcemia, and 29 healthy subjects. Serum bone GLA-protein was increased in primary hyperparathyroidism (17.6 ± 3.9 ng/ml) and normal in hypercalcemia of malignancy (5.2 ± 2.8 ng/ml; p < 0.001 vs hyperparathyroidism) and in normocalcemic patients with bone metastases. In primary hyperparathyroidism parathyroid hormone correlated positively with urinary calcium excretion (p < 0.05) and with urinary hydroxyproline excretion (p < 0.001). The sensitivity of serum bone GLA-protein measurements in differentiating between primary hyperparathyroidism and hypercalcemia of malignancy was 91 % and the specificity 84 %. Thus this marker appears to be a useful tool for the differential diagnosis of hypercalcemias.
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