musculoskeletal and connective tissue disorders
Paget Disease of Bone
Treatment of Paget Disease of Bone
Supportive care for symptoms and complications Bisphosphonates if bone disease is symptomatic or active in bones at risk of complications Supportive treatment of Paget disease of bone includes analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs) for pain. Orthotics help correct abnormal gait caused by bowed lower extremities. Some patients require orthopedic surgery (eg, hip or knee replacement, decompression of the spinal cord). Weight bearing should be encouraged, and bed rest should be avoided. Localized, asymptomatic disease may not require treatment. Pharmacologic therapy is indicated to treat pain clearly related to the pagetic process and not to another source (eg, osteoarthritis). In addition, some guidelines ( Treatment references ) recommend treatment to Prevent or retard progression of complications (eg, hearing loss, deformity, osteoarthritis, paraparesis or paraplegia related to vertebral Paget disease, or other neurologic deficits), particularly in a poor surgical candidate Prevent or minimize bleeding if orthopedic surgery is planned at a site with pagetic involvement Suppress excessive osteoclast activity when serum alkaline phosphatase (of bony origin) is>2 times the normal level, even in the absence of symptoms Although disease progression can be retarded by medications, existing deficits (eg, deformity, osteoarthritis, hearing loss, neural impingement) are not reversed. Several antiresorptive agents that suppress osteoclast activity and decrease bone pain are available for treating Paget disease. is recommended as first-line therapy for Paget disease of bone in professional guidelines ( Treatment references , may also be an alternative to bisphosphonates ( Treatment references ); however, there are insufficient data to support its routine use. Because bone turnover is increased, patients should ensure adequate intake of calcium andvitamin D, and supplements are often needed. 1.Singer FR, Bone HG 3rd, Hosking DJ, et al: Paget's disease of bone: an Endocrine Society clinical practice guideline.J Clin Endocrinol Metab99(12):4408-22, 2014. doi: 10.1210/jc.2014-2910 2.Reid IR, Lyles K, Su G, et al: A single infusion ofzoledronic acidproduces sustained remissions in Paget disease: Data to 6.5 years.J Bone Miner Res26(9):2261–2270, 2011. doi: 10.1002/jbmr.438 3.Reid IR, Sharma S, Kalluru R, Eagleton C: Treatment of Paget's disease of bone withdenosumab: Case report and literature review.Calcif Tissue Int99(3):322–325, 2016. doi: 10.1007/s00223-016-0150-6 