Rheumatology Advance Access originally published online on June 8, 2004
Rheumatology 2004 43(8):955-959; doi:10.1093/rheumatology/keh243
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Rheumatology Vol. 43 No. 8 © British Society for Rheumatology 2004; all rights reserved
Review |
Management of Paget's disease of bone
Health Services Research Unit and 1 Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK.
Correspondence to: S. H. Ralston, Institute of Medical Sciences, Foresterhill, Aberdeen AB25 2ZD, UK. E-mail: s.ralston{at}abdn.ac.uk
Paget's disease of bone is a common condition with a strong genetic component, characterized by focal increases in bone turnover, affecting one or more bones throughout the skeleton. Paget's disease can be asymptomatic but is frequently associated with bone pain, bone deformity, pathological fracture, secondary osteoarthritis and deafness. Inhibitors of osteoclastic bone resorption, such as bisphosphonates and calcitonin, suppress bone turnover and improve bone pain in Paget's disease. Many patients also require therapy with analgesics and anti-inflammatory agents, since pain in Paget's disease can arise not only from increased bone turnover but also from complications such as osteoarthritis and nerve compression syndromes, which do not respond well to antiresorptive therapy. Comparative studies have shown that second- and third-generation bisphosphonates, such as tiludronate, alendronate and risedronate, are more effective than etidronate at inhibiting bone turnover in Paget's disease but they have not been found to be significantly more effective in controlling bone pain. Importantly, none of the treatments that are currently available for Paget's disease have been shown to prevent complications such as deafness, fracture or bone deformity, or to alter the natural history of the disease. More research is required to define the long-term effects of antiresorptive treatment on clinical outcomes in Paget's disease, so that clinicians and their patients can make better-informed choices about the risks and benefits of treatment.
KEY WORDS: Paget's disease, Bone, Management, Bisphosphonate, Calcitonin
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  D.B. Kimmel Mechanism of Action, Pharmacokinetic and Pharmacodynamic Profile, and Clinical Applications of Nitrogen-containing Bisphosphonates J. Dent. Res., November 1, 2007; 86(11): 1022 - 1033. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. K. Das and K. Schwarz Mono-osteotic Paget's disease of the hand Age Ageing, March 1, 2007; 36(2): 229 - 229. [Full Text] [PDF]
|
|
|
|
 |
|
 B. Rhodes and A. S. M. Jawad Paget's disease of bone: osteitis deformans or osteodystrophia deformans? Rheumatology, February 1, 2005; 44(2): 261 - 262. [Full Text] [PDF]
|
|
|
|
|
|
S. H. Ralston and A. L. Langston Management of Paget's disease of bone: reply Rheumatology, February 1, 2005; 44(2): 262 - 262. [Full Text] [PDF]
|
|
|
|
|
|
A. J. Crisp The treatment of Paget's disease Rheumatology, February 1, 2005; 44(2): 262 - 263. [Full Text] [PDF]
|
|