Intravenously administered pamidronate for treating refractory Paget's disease of bone.
OBJECTIVE
To report our experience with the use of intravenously administered pamidronate in 16 patients with refractory Paget's disease of bone.


METHODS
We describe our treatment regimen and outline serum alkaline phosphatase levels at baseline and after pamidronate therapy in our study cohort. In addition, we summarize clinical symptoms and response to treatment.


RESULTS
Although clinical experience with pamidronate in the treatment of Paget's disease of bone has been limited in the United States, elsewhere it has been shown to be an effective agent that inhibits the increased osteoclastic activity characteristic of this disease. Accordingly, in 16 patients with Paget's disease unresponsive to various other therapies, we administered pamidronate intravenously at a dose of 30 mg in 500 mL of 5% dextrose in water during a 4-hour period once weekly for 6 weeks. Serum alkaline phosphatase was determined at baseline and at regular intervals for at least 12 months after the onset of therapy. Many of these patients reported relief of pain and an increased flexibility or range of motion after treatment. The only adverse effect reported by these patients was an acute-phase reaction during the first infusion in two patients. In all patients, serum alkaline phosphatase levels declined, and significant (P = 0.0012) decreases from baseline were noted within 6 weeks after the initial infusion. Maximal responses were generally seen within 6 months after treatment, serum alkaline phosphatase levels decreasing as much as 91% from baseline.


CONCLUSIONS
These data suggest that intravenous pamidronate therapy is an effective alternative to calcitonin and etidronate in the treatment of Paget's disease of bone, particularly in those patients refractory to such agents.
de la Rosa
R E
RE
Roger Williams Medical Center, Providence, Rhode Island 02908-4735, USA.
Tucci
J R
JR