Alendronate. Alendronate is available for the treatment of Paget’s disease in most western countries (Fosamax 40). The recommended dose is 40 mg daily for 6 months to be taken with a large glass of water (>200 ml) on getting up in the morn­ing after an overnight fast. The patient is instructed not to take anything [...]

Bisphosphonates are currently regarded as the treatment of choice and the only realistic therapeutic option, but in the near future other therapies (for example, anti-RANKL agents) may become available. Here we discuss the individual compounds, considering the evidence of their efficacy and the most com­monly used therapeutic regimens. With the sole exception of etidronate, the [...]

The primary objective of Paget’s disease treatment is the relief of symptoms, and the new bisphosphonates are the agents most likely to relieve the aches and pain, excessive warmth over affected bone, headache due to skull involvement, low- back pain secondary to pagetic vertebral changes, and effects of nerve compression associated with the condition. Even [...]

Introduction The treatment of Paget’s disease of bone (Paget’s disease) is based on the use of agents capable of suppressing the abnor­mal activity of pagetic osteoclasts. Paget’s disease was an un- treatable condition until the mid-1970s when calcitonin became available and was registered in most countries for the treatment of the disease. Calcitonin was administered [...]

An association between hypercalciuria and renal phosphate leak was first described by Bordier et al., who speculated that a primary defect of phosphate reabsorption at the proximal renal tubule could be responsible for hypophosphatemia, acti­vation of the renal 1 a-25(OH)2 vitamin D3 hydroxylase and par­tial inhibition of PTH secretion. The associated hypercalciuria would ensue from [...]

Bisphosphonates are widely used to prevent osteoporosis and, among these, alendronate and risedronate, exhibit a favourable efficacy/safety profile over long-term use. Theoretically, if increased bone resorption partly explained id- iopathic hypercalciuria, it follows that drugs capable of reduc­ing the rate of bone turnover should also have some effect on calcium excretion. Alendronate, 20 mg daily, [...]

Citrate supplementation, as alkaline potassium salt, was for­merly introduced in the treatment of distal renal tubular acido- sis and subsequently extended to idiopathic hypocitraturic calcium nephrolithiasis. Regardless of the accompanying cation (sodium, potassium, magnesium) citrate salts exhibit di­rect effects on calcium excretion, acting by two distinct mecha­nisms: first, citrate anion is a strong ligand of [...]