Diseases such as multiple myeloma and primary hyperparathyroidism are occasionally found in the elderly. Although very rare, the coexistence of both in the same patient has been described in the literature. The coincidence of manifestations of both diseases, namely hypercalcemia and osteopenia, may difficult the diagnosis, turning it into a challenge. The authors report a case of a female patient in whom the investigation of hypercalcemia and musculoskeletal manifestations led to a simultaneous diagnosis of multiple myeloma and primary hyperparathyroidism. With this case, they also emphasise clinical and radiological manifestations of these diseases, nowadays rarely observed, and related to the long time clinical evolution.
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