The treatment of Paget’s
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 by subcutaneous injections at doses (100 IU/day) that were often poorly tolerated. The treatment proved able to alleviate bone pain within a few weeks, but the observed decreases in the activity of the disease, as assessed by bone turnover markers, was often inadequate. In the early ’80s the bisphosphonate etidronate was introduced. This had to be used at sub-optimal doses (10 mg/kg/day) because at higher doses etidronate therapy is associated with the development of osteomalacic features. Thus, in a large proportion of patients, neither calcitonin nor etidronate were able to suppress the disease activity completely.
These agents were replaced in the ’90s by the newer bisphos- phonates (clodronate, tiludronate, pamidronate, alendronate and risedronate), progressively more potent than etidronate, and potentially able to achieve greater disease suppression and frank remission (i.e., normalisation of pagetic indices) for prolonged periods. In addition to these bisphosphonates, others have been studied in some countries (olpadronate and ner- idronate) or are still awaiting final registration (ibandronate, zoledronate).
In the USA, gallium nitrate was also registered for the treatment of Paget’s disease and there have been some attempts to treat the disease with anti-viral agents. In many patients the complications of Paget’s disease require additional symptomatic treatments, including analgesics, anti- inflammatory drugs, and selected orthopaedic and neurosurgi- cal interventions, but here we focus on the treatment of the metabolic disease.
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