title: Normal bone turnover markers in a patient with active Paget's disease of bone: response to treatment with zoledronic acid.
abstract: The treatment of Paget's disease of bone (PDB) aims at the suppression of abnormal bone turnover; bisphosphonates are currently the treatment of choice. Indications for antiresorptive treatment in symptomatic patients with PDB include bone or joint pain, neurological complications, surgery planned at an active pagetic site and hypercalcaemia from immobilisation. The goals of antiresorptive treatment are clinical improvement and biochemical remission, as assessed by the normalisation of bone turnover markers. Clinical deterioration, especially bone pain, should be considered before deciding to treat patients with late sclerotic (burned-out) PDB. Bone scintigraphy may be of importance in these patients, because it depicts increased osteoblastic activity, when bone markers may not. We present a case of late sclerotic PDB with clinical deterioration but normal bone turnover markers, who experienced significant clinical improvement after treatment with zoledronic acid.
authors.affiliation: Second Medical Clinic, Medical School, Aristotle University of Thessaloniki, Ippokration Hospital, Greece. stergios@endo.gr
authors.forename: Stergios A
authors.initials: SA
authors.lastname: Polyzos
authors.forename: Athanasios D
authors.initials: AD
authors.lastname: Anastasilakis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Anagnostis
authors.forename: Marina
authors.initials: M
authors.lastname: Kita
authors.forename: Georgios
authors.initials: G
authors.lastname: Arsos
authors.forename: Efstratios
authors.initials: E
authors.lastname: Moralidis
authors.forename: Athanasios
authors.initials: A
authors.lastname: Papatheodorou
authors.forename: Evangelos
authors.initials: E
authors.lastname: Terpos
mesh_terms: D000368:Aged; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D016723:Bone Remodeling / Q000187:drug effects*; D004164:Diphosphonates / Q000627:therapeutic use*; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D010001:Osteitis Deformans / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid