title: Osteomalacia in a patient with Paget's bone disease treated with long-term etidronate.
abstract: A 93 year-old woman with Paget's disease of bone had been treated with etidronate without interruption during 20 years. The daily dose was usual (5mg/kg/day) but this prescription had never been stopped by her physicians. Two fractures had already occurred in pagetic (right tibia) and non pagetic bones (right fibula) within the last 2 years, and she presented rib fractures, another right tibia fracture and right femur fracture during hospitalization time. X-rays films showed major osteolysis of left ulna and right tibia. Blood samples and technetium bone scan brought no evidence for sarcoma or lytic evolution of the disease. A transiliac bone biopsy on non pagetic bone site confirmed the diagnosis of osteomalacia (increased osteoid parameters), with secondary hyperparathyroidism (hook resorption). In Paget's disease of bone, continuous treatment by etidronate may induce generalized osteomalacia, and increase the risk of fracture in both pagetic and non-pagetic bones. Whereas physicians and pharmaceutical industry try to improve the observance of those drugs, this striking observation also points out that a prescription always needs to be updated.
authors.affiliation: Service de rhumatologie, CHU, 49933 Angers cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Hoppé
authors.forename: C
authors.initials: C
authors.lastname: Masson
authors.forename: A
authors.initials: A
authors.lastname: Laffitte
authors.forename: D
authors.initials: D
authors.lastname: Chappard
authors.forename: M
authors.initials: M
authors.lastname: Audran
mesh_terms: D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood; D001706:Biopsy; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D002113:Calcification, Physiologic / Q000187:drug effects; D002119:Calcium Carbonate / Q000627:therapeutic use; D002762:Cholecalciferol / Q000627:therapeutic use; D012968:Etidronic Acid / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D005264:Femoral Fractures / Q000209:etiology; D005360:Fibula; D005598:Fractures, Spontaneous / Q000209:etiology*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000139:chemically induced; D007049:Iatrogenic Disease; D010001:Osteitis Deformans / Q000150:complications / Q000188:drug therapy*; D010014:Osteolysis / Q000097:blood / Q000139:chemically induced / Q000000981:diagnostic imaging; D010018:Osteomalacia / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy; D010281:Parathyroid Hormone / Q000097:blood; D011877:Radionuclide Imaging; D012253:Rib Fractures / Q000209:etiology; D013978:Tibial Fractures / Q000209:etiology; D014457:Ulna / Q000473:pathology; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D050071:Bone Density Conservation Agents; D010281:Parathyroid Hormone; D014807:Vitamin D; D002762:Cholecalciferol; C104450:25-hydroxyvitamin D; D000469:Alkaline Phosphatase; D002119:Calcium Carbonate; D012968:Etidronic Acid