bisphosphonates in the treatment of Paget's disease
Last reviewed 01/2018
- bisphosphonates are the mainstay of treatment of Paget's disease
- lead to inhibition of bone resorption
- bind to calcium hydroxyapatite - leads to prevention of bone turnover
- cellular effects - inhibition of osteoclast function, induction of apoptosis, reduction of production and activity of bone-remodelling units
- routes and dosages vary with respect to different bisphosphonates
- usually they are poorly absorbed from the gastrointestinal tract
- oral drugs should be taken on an empty stomach at least half an hour before the intake of food or drink (1)
- disodium etidronate was the first bisphosphonate to be used in the management of Paget's disease. However this drug may be associated with bone demineralisation and is relatively ineffective and second- and third- generation bisphosphonates have been developed
- all of the second- and third- generation bisphosponates lead to (1):
- a reduction in indices of bone turnover in 80%
- result in a biochemical remission in 50-75% of patients after a single course of treatment
- result in new bone formation with a lamellar pattern
- these bisphosphonates rarely result in bone mineralisation abnormalities (2)
- these drugs should be prescribed only following consultation of their respective summary of drug characteristics
- in general, treatment should be with an oral second- or third- generation bisphosphonate in the initial management of Paget's disease requiring treatment; the use of intravenous therapy may be indicated if there oral therapy is ineffective; neurological complications are also an indication for intravenous therapy (3)
- newer drugs such as zoledronate has been shown to be the most potent drug in the bisphophnate family with profound suppression of disease activity (2)
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