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. 2019 Jan-Feb;23(1):117-121.
doi: 10.4103/ijem.IJEM_327_18.

Response to Zoledronic Acid in Patients with Active Paget's Disease of Bone: A Retrospective Study

Harsh Durgia  1 , Jayaprakash Sahoo  1 , Sadishkumar Kamalanathan  1 , Rajan Palui  1 , Ritesh Kumar  1 , Dhanapathi Halanaik  2 , Ramesh Ananthakrishnan  3 , Gowri Sankar  2 , Kalyani Sridharan  1 , Henith Raj  1
Affiliations

Response to Zoledronic Acid in Patients with Active Paget's Disease of Bone: A Retrospective Study

Harsh Durgia et al. Indian J Endocrinol Metab. 2019 Jan-Feb.

Abstract

Background: Traditionally, bisphosphonates are used to treat active Paget's disease of bone (PDB). Intravenous zoledronic acid (ZA) is the most effective treatment option leading to sustained remission.

Objective: The primary objective of this study was to analyze the effect of intravenous ZA in patients with active PDB in a tertiary care center of India.

Materials and methods: Retrospective data of 13 patients with active PDB who received a single dose of 4 mg intravenous ZA at our institute from January 2011 to June 2017 were reviewed. Response to therapy was monitored clinically, biochemically by serum alkaline phosphatase (ALP), and scintigraphically by 99m-Technetium methylene diphosphonate bone scan.

Results: All of our patients reported relief of bone pain. The mean duration of follow-up in our study was 35.2 ± 16.8 months. Serum ALP levels reduced significantly from 1190.9 ± 666.1 IU/L (n = 13) at baseline to 200.5 ± 68.4 IU/L (n = 13) at 6 months (P < 0.001). ALP level at 1 year was 174 ± 33.6 IU/L (n = 12), which remained stable till 36 months at 176.5 ± 50 IU/L (n = 8). This indicates that remission achieved by 6 months post ZA is sustained for at least 3 years. Scintigraphic ratio reduced from 9.6 [interquartile range (IQR) 5.25-18.2] at baseline to 2.7 (IQR 1.20-4.05) at follow-up (P < 0.001). Similarly, scintigraphic index of involvement reduced from 9.9 (IQR 5.6-28.5) at baseline to 3 (IQR 2-4) at follow-up (P = 0.018).

Conclusion: A 4 mg single dose of intravenous ZA results in clinical, biochemical, and scintigraphic response that is sustained for at least 3 years.

Keywords: Bisphosphonates; Paget's disease of bone; remission; zoledronic acid.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Patient disposition, treatment, and outcome
Figure 2
Figure 2
Anterior and posterior view of whole-body bone scan performed in a 60-year-old male with Paget's disease. (a) Pretreatment baseline images show intense increased uptake involving entire skull, upper cervical vertebrae, right upper ribs, sacrum, right hemipelvis, and entire left femur. (b) Follow-up of whole-body bone scan images show significant regression in uptake of all the lesions and skeletal index of involvement also shows reduction from 29 to 4.8
See this image and copyright information in PMC

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