Proposed new approach for treating Paget's disease of bone.
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.


OBJECTIVE
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.
St. Michaels Hospital, Lower George's Street, Dún Laoghaire, Co. Dublin, Ireland.
W
W
Mahmood
M J
MJ
McKenna
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D050071:Bone Density Conservation Agents / Q000378:metabolism / Q000627:therapeutic use*; D004164:Diphosphonates / Q000378:metabolism / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010001:Osteitis Deformans / Q000188:drug therapy*
D050071:Bone Density Conservation Agents; D004164:Diphosphonates