indications for treatment of Paget's disease

Last reviewed 01/2018

The following has been provided as potential indications for antiresorptive treatment in Paget's disease (1):

  • pain in pagetic bone
    • is the only symptom with firm evidence that therapy confers a clinical benefit
    • it is important to differentiate bone pain resulting from pagetic activity (usually present at rest) which responds to antipagetic drugs from pain in a bone and/or joint deformity which occurs as a consequence of the disease (e.g. - osteoarthritic pain) which respond to analgesics, but not to antipagetic drugs (1)
  • other indications in both symptomatic and asymptomatic patients with metabolically active PDB requiring therapy include
    • those with involvement of long bones at risk of future bowing deformities
    • those with extensive skull involvement at risk for future hearing loss
    • those with pagetic changes in one or more vertebrae with the risk of various neurological complications
    • those with PDB in bones adjacent to major joints with the risk of secondary arthritis
  • complications caused by Paget's disease - treatment needs to be administered at an early stage of the disease (1)
  • prior to orthopaedic surgery (2)
  • hypercalcaemia resulting from immobilization (3).

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