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BUPA and consultants over 70

of calcipotriol for one week followed by 300 g for a second week. Mean serum calcium concentration rose from 2 26mmol/1 to 2-33mmolQ (p<0-01; normal values 2 1-2-6mmolI/) and mean urinary calcium excretion from 4-79 mmol/24 h to 7-27mmol/24h (p<0-01). None ofthem developed hypercalcaemia, and in all of them changes in serum calcium concentration were seen within the first two weeks of treatment, values falling rapidly (two weeks) after withdrawal of calcipotriol. This is to be expected given the rapid systemic metabolism of calcipotriol and the inactivity of its metabolites.5 We suggest that delayed hypercalcaemia in the two patients of Hardman and colleagues is an unexpected event. On the basis of these two cases the authors recommend monitoring serum calcium concentration routinely in patients using calcipotriol. Before this recommendation can be accepted other causes of hypercalcaemia must be excluded in these cases. All other available evidence indicates that serum calcium concentration remains unaltered with a dose of less than lOOg of calcipotriol a week. At the upper limit of the recommended dose there is a small effect on calcium homoeostasis. This is detectable by measuring urinary calcium excretion but serum calcium concentration is unchanged.