An eight-year-old female spayed rabbit presented with lethargy, anorexia, and absent defecation. Blood exam revealed elevated total calcium and hypophosphatemia. Without other significant finding of renal disorder, intact parathyroid hormone (PTH) was evaluated. Although no established reference range for rabbit PTH, patient’s PTH level was higher than other clinical healthy rabbits, leading to a strong suspicion of primary hyperparathyroidism. Due to personal consideration, owner opted for Fosamax (alendronic acid 4 mg/kg PO q7d) as an alternative to surgery. However, follow-up examinations revealed persistent hypercalcemia, bilateral humeral fractures, and acute renal injury. Euthanasia was conducted for low life quality. Necropsy indicated multiple bone fractures with osteomalacia and right parathyroid gland enlargement. Histological examination confirmed parathyroid chief cell adenoma accompanied by metabolic bone disease. The case exhibited clinical signs similar to those of classical complication of hyperparathyroidism in humans, affecting both skeletal and renal systems. While there is limited data on bisphosphonate use in rabbits, oral administration appeared less effective in reducing calcium levels and improving bone density. The case implicates similarities in the pathophysiology of primary hyperparathyroidism between rabbits and humans. In addition, medical treatment of bisphosphonate should not be primary and sole therapy in rabbits’ primary hyperparathyroidism.