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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