Indications for treatment of Paget's disease

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).

Reference:

• (1) Michou L, Brown JP. Emerging strategies and therapies for treatment of Paget's disease of bone. Drug Des Devel Ther. 2011;5:225-39.
• (2) Langston AL, Ralston SH. Management of Paget's disease of bone. Rheumatology (Oxford). 2004;43(8):955-9.
• (3) Whyte MP. Clinical practice. Paget's disease of bone. N Engl J Med.2006;355(6):593-600.