Proposed new approach for treating Paget's disease of bone

Abstract

Background: Paget's disease of the bone (PDB) is a localized disorder of bone remodeling. Nitrogen-containing bisphosphonates (N-BPs) are the treatment of choice.

Aim: We aimed to determine the effectiveness of N-BPs in our practice.

Methods: We prospectively tabulated clinical, imaging and biochemical data as well as interventions.

Results: All patients (n = 31) received one or more different N-BPs such as alendronate, risedronate, and zoledronic acid (ZA). Median (absolute range) serum total alkaline phosphatase (ALP) declined from 302 (55-1,600) to 69 (37-101) IU/L. In a subgroup of patients (n = 18) who received ZA after receiving an oral N-BP, median serum total ALP declined from 197 (44-1, 603) to 65 (37-95) IU/L.

Conclusions: Newly diagnosed patients with PDB should be treated for 6 months with oral N-BPs prior to administration of intravenous ZA. Repeat ZA infusions are necessary only if the serum total ALP levels rise above normal, or if symptoms or complications attributable to PDB persist.