Materiały źródłowe

• #1 Paget’s disease of bone – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pagets-disease-of-bone/diagnosis-treatment/drc-20350816

  If you don’t have symptoms, you might not need treatment. However, if the disease is active indicated by an elevated alkaline phosphatase level and is affecting high-risk sites in your body, such as your skull or spine, your doctor might recommend treatment to prevent complications, even if you don’t have symptoms. […] Osteoporosis drugs (bisphosphonates) are the most common treatment for Paget’s disease of bone. Bisphosphonates are typically given by injection into a vein, but they can also be taken by mouth. When taken orally, bisphosphonates are generally well tolerated but can irritate the stomach. […] Rarely, bisphosphonate therapy has been linked to severe muscle, joint or bone pain, which might not resolve when the medication is discontinued. Bisphosphonates can also increase the risk of a rare condition in which a section of jawbone dies and deteriorates, usually associated with active dental disease or oral surgery.

• #1 Paget’s Disease of Bone: Diagnosis, Treatment, and Steps to Take

  https://www.niams.nih.gov/health-topics/pagets-disease-bone/diagnosis-treatment-and-steps-to-take

  If you do not have symptoms, you may not need treatment. However, if your disease is active, you have symptoms, or you have a higher chance of developing complications, your doctor may recommend treatment. The goal of your treatment is to: […] Doctors can recommend several options to help treat Pagets disease, prevent complications of the disease and promote bone health, including: […] Treatment can help you manage your symptoms but does not cure the disease. […] The primary medications your doctor may prescribe to treat Pagets disease include: […] Although medications can regulate bone growth and minimize complications, surgery may be necessary to correct problems from the complications of the disease, such as: […] If you have Pagets disease, you do not need a special diet. However, it is important that you keep your bones strong.

• #1 Diagnosis and Management of Paget’s Disease of Bone in Adults: A Clinical Guideline

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6522384/

  An evidencebased clinical guideline for the diagnosis and management of Paget’s disease of bone (PDB) was developed using GRADE methodology, by a Guideline Development Group (GDG) led by the Paget’s Association (UK). […] Twelve recommendations and five conditional recommendations were made, but there was insufficient evidence to address eight of the questions posed. The following recommendations were identified as the most important: 1) Radionuclide bone scans, in addition to targeted radiographs, are recommended as a means of fully and accurately defining the extent of metabolically active disease in patients with PDB. 2) Serum total alkaline phosphatase (ALP) is recommended as a firstline biochemical screening test in combination with liver function tests in screening for the presence of metabolically active PDB. 3) Bisphosphonates are recommended for the treatment of bone pain associated with PDB. Zoledronic acid is recommended as the bisphosphonate most likely to give a favorable pain response. 4) Treatment aimed at improving symptoms is recommended over a treattotarget strategy aimed at normalizing total ALP in PDB. 5) Total hip or knee replacements are recommended for patients with PDB who develop osteoarthritis in whom medical treatment is inadequate.

• #1 Paget’s Disease of the Bone: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/21929-pagets-disease-of-the-bone

  Treatments for Pagets disease of the bone can include: […] Medication: Many medications can treat Pagets disease of the bone. The most common type is bisphosphonates. The most effective bisphosphonate is zoledronate (Reclast). Often, one dose of this drug can result in long-lasting remission of the disease but it cant correct bone deformities. […] Surgery: You might need surgery to fix or improve complications of Pagets disease of the bone. Some surgeries include knee or hip replacements, surgery to realign deformed bone and surgery to enable bone fractures to heal in a better position. […] There’s currently no cure for Pagets disease of the bone, but its treatable. The sooner Pagets disease can be diagnosed and treated, the less likely that youll experience complications from the disease. […] Pagets disease of the bone is a chronic (lifelong) condition but its treatable. It often gets worse slowly over time if it isnt treated.

• #1 Paget Disease Treatment & Management: Approach Considerations, Bisphosphonates and Calcitonin Analogues, Neoplasm

  https://emedicine.medscape.com/article/334607-treatment

  The following prescription drugs have been approved and are available for treating Paget disease in the United States: Etidronate, Pamidronate, Alendronate, Tiludronate, Risedronate, Zoledronic acid, Calcitonin salmon. […] Pamidronate, zoledronic acid, and calcitonin salmon are administered parenterally. […] Retreatment is indicated if a patient has not responded after 6 months following treatment or if clinical or biochemical relapse occurs. […] The PRISM study, a randomized trial, concluded that intensive bisphosphonate therapy confers no clinical advantage over symptom-driven management in patients with established Paget disease. […] In patients who present with Paget disease at an older age, treatment may require only a single intravenous infusion of zoledronic acid. […] In one study, 6 months of oral alendronate at the recommended 40-mg regimen produced normalization of alkaline phosphatase in 63% of patients with Paget disease, compared with 17% after treatment with 400 mg/day of etidronate.

• #1 Paget Disease Treatment & Management: Approach Considerations, Bisphosphonates and Calcitonin Analogues, Neoplasm

  https://emedicine.medscape.com/article/334607-treatment

  Anderson et al induced biochemical remission with one or more complex courses of pamidronate in 90% of patients with elevated alkaline phosphatase levels. […] In a comparative study, normalization of alkaline phosphatase was achieved in 77% of patients treated with risedronate, compared with 10% using a 400-mg etidronate regimen. […] When given for 12 weeks, a daily regimen of 400 mg of tiludronate reduced alkaline phosphatase activity by 58% at 24 weeks. […] In a randomized, double-blind trial comparing a single intravenous infusion of 5 mg of zoledronic acid with oral administration of 30 mg of risedronate daily for 2 months, normalization of alkaline phosphatase levels was achieved at 6 months in 89% and 58% of patients, respectively. […] A study by Devogelaer and colleagues examining Paget disease remission after treatment with a 5 mg intravenous infusion of zoledronic acid in routine clinical practice found effectiveness and safety data similar to those observed in the original trial populations.

• #1 Paget’s disease of bone – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pagets-disease-of-bone/diagnosis-treatment/drc-20350816

  If you can’t tolerate bisphosphonates, your doctor might prescribe calcitonin (Miacalcin), a naturally occurring hormone involved in calcium regulation and bone metabolism. Calcitonin is a drug that you administer to yourself by injection or nasal spray. Side effects may include nausea, facial flushing and irritation at the injection site. […] In rare cases, surgery might be required to: Help fractures heal, Replace joints damaged by severe arthritis, Realign deformed bones, Reduce pressure on nerves. […] If you’re scheduled for surgery that involves bones affected by Paget’s disease of bone, your doctor might prescribe medications to reduce the activity of the disease, which may help reduce blood loss during surgery.

• #1 Treatment | Paget’s Association

  https://paget.org.uk/pagets-disease/what-is-pagets-and-how-is-it-managed/treatment/

  Bisphosphonates can also be given as tablets; these are slightly less effective than an infusion of zoledronic acid, at reducing bone remodelling, and the effect doesnt last quite as long. […] The most commonly used oral treatment is 30mg of risedronate sodium, taken daily, for two months. […] Pamidronate is an effective treatment but has largely been superseded by zoledronic acid which lasts longer and is easier to administer. […] In some cases where bisphosphonates are not recommended, calcitonin injections may be considered to treat bone pain in Pagets disease. […] A comprehensive review on the effects of bisphosphonates in the treatment of Pagets disease, published in 2017, concluded that serious side effects were rare and that the most common side effects experienced were a flu-like illness in people given bisphosphonates by infusion, and stomach upset in those given tablets.

• #1 Paget’s disease of bone: A clinical update

  https://www1.racgp.org.au/ajgp/2021/january-february/pagets-disease-of-bone

  In a Cochrane review, bisphosphonates resulted in a 50.1% greater reduction in total ALP than placebo and were far more likely to normalise the total ALP. […] The duration of the effect on bone turnover is also longer after zoledronic acid than other bisphosphonates. […] This has led to the recommendation that bisphosphonate therapy should be reserved for use in symptomatic PDB and focus on symptom management rather than suppression of bone turnover. […] Denosumab is an alternative antiresorptive therapy used for patients with osteoporosis; however, it has been less studied in PDB than bisphosphonates. […] Treatment response is best assessed by measuring serum total ALP 36 months after treatment and then annually once levels are normalised. […] If symptoms recur and serum ALP rises above the normal range, retreatment with zoledronic acid should be considered. […] Zoledronic acid is highly effective in treating symptomatic disease, with high rates of long-term remission.

• #1 Paget’s disease of bone | Causes, symptoms, treatments

  https://versusarthritis.org/about-arthritis/conditions/pagets-disease-of-bone/

  Infusions of bisphosphonates are given in hospital and each one usually takes about 1530 minutes. The advantage of infusions is that all the drug is all absorbed into the body. However, the condition can also be treated with tablets, which you may find more convenient. […] If you cant take bisphosphonates because of side effects, your doctor might suggest daily injections of a drug called calcitonin instead. […] If you have pain resulting from joint damage or pressure on the nerves, then you may also need painkillers such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. […] It may be helpful to see a physiotherapist. […] Surgery isnt usually needed for Pagets disease, but can sometimes be helpful for other problems linked to Pagets disease for example: […] Its important that people with Pagets disease eat a good diet with enough calcium and vitamin D. […] Theres no research to suggest that any form of complementary medicine is helpful for Pagets disease.

• #1

  https://arthritis.ca/about-arthritis/arthritis-types-(a-z)/types/paget-s-disease

  You can also use over-the-counter medications to address the pain from Pagets disease. These include acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs). […] The following healthcare professionals have advanced training and are registered to practice by their respective provincial/territorial colleges: A physiotherapist (PT) can develop an individualized rehabilitation program designed to help you increase your strength, flexibility, range of motion and general mobility and exercise tolerance through a wide variety of therapeutic treatments and strategies. These can help you reduce falls and prevent bone fractures. […] An occupational therapist (OT) can look at your activities of daily living and develop a program to help lessen your symptoms and improve your function. An OT can do a home or workplace assessment to identify ways to protect your joints and can recommend tools and aids to help you conserve energy and improve your independence. For example, this could include use of a cane and raised seats to decrease stress on your hip and knee joints.

• #1 Paget Disease Treatment & Management: Approach Considerations, Bisphosphonates and Calcitonin Analogues, Neoplasm

  https://emedicine.medscape.com/article/334607-treatment

  Drug therapy for Paget disease should include bisphosphonate treatment with serial monitoring of bone markers. […] Patients should receive 1000-1500 mg of calcium and at least 400 U of vitamin D daily. This recommendation is especially important in conjunction with bisphosphonate treatments. […] Secondary osteoarthritic pain may be reduced by nonsteroidal anti-inflammatory drugs (NSAIDs) or other nonnarcotic analgesics. […] Orthotic devices, including canes and walkers, may be useful for patients with gait abnormalities resulting from Paget disease that involves the lower limbs. […] Because of the increased risk of malignancy, patients with Paget disease should be monitored indefinitely. Chemotherapy, radiation, or both may be used to treat neoplasms that arise from pagetic bone. Amputation may also be necessary in the presence of a malignant transformation.

• #1 Treatment of Paget’s Disease of Bone | Reumatología Clínica

  https://www.reumatologiaclinica.org/en-treatment-paget39s-disease-bone-articulo-S2173574312000159

  The mainstay of treatment of the PD is the use of antiresorptive agents in order to reduce high bone turnover and osteoclast activity. Over the years various drugs have been used, but since the introduction of bisphosphonates in 1970, they have become the antiresorptive treatment of choice. […] The most recently introduced bisphosphonate in the treatment of PD is zoledronic acid. It is a bisphosphonate that has shown affinity for hydroxyapatite in vitro and the most potent antiresorptive we currently have. […] Another fundamental aspect in the treatment of PD is calcium (1000mg) and vitamin D (400800IU) supplementation in patients receiving antiresorptive therapy to prevent hypocalcemia and secondary hyperparathyroidism. […] Apart from specific treatment, we must effectively manage symptoms. The main symptom is pain, which may not always be derived from the activity of the disease, but may be secondary to complications and localized lesions.

• #1 Treatment | Paget’s Association

  https://paget.org.uk/pagets-disease/what-is-pagets-and-how-is-it-managed/treatment/

  The decision to give treatment may be modified if you have another medical problem which could be aggravated by bisphosphonates. […] An assessment of the response to treatment should take place between 3 and 6 months after the course of treatment has been completed. […] Although bisphosphonates can help reduce bone pain, some patients require a painkilling drug (analgesic) for maximum pain relief, particularly if there is significant osteoarthritis in major joints. […] Calcium is vital for the development of healthy bones, whilst vitamin D is required to help regulate the way your body uses calcium, and to ensure your bones, muscles and teeth remain strong. […] Surgery may be required to treat complications of Pagets disease such as fractures, osteoarthritis and when bone enlargement is thought to be compressing the nerves in the spine. Prior to surgery, it is usual for bisphosphonate treatment to be administered in the hope that this might reduce blood loss, which can occur in Pagets disease, due to the increased vascularity of affected bone.

• #1 Treatment of Paget’s Disease of Bone | Reumatología Clínica

  https://www.reumatologiaclinica.org/en-treatment-paget39s-disease-bone-articulo-S2173574312000159

  There are five main indications for surgical treatment: Fractures, Deformity: that cause pain when they are difficult to control or associated with bone fissures, corrected through the use of osteotomy, Pagetic arthropathy: arthroplasty when symptoms are not effectively controlled with medical treatment, Entrapment neuropathies and myelopathies, Cancer. […] Biomarkers of bone turnover indirectly estimate the activity of the disease and are therefore used in the assessment of treatment response in conjunction with the clinical response. […] The need for a new cycle of treatment occurs when there is a new increase of bone remodeling.

• #1 Patient education: Paget disease of bone (osteitis deformans) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/paget-disease-of-bone-osteitis-deformans-beyond-the-basics

  Synthetic calcitonin is a hormone that is given as an injection under the skin several times a week. Calcitonin may be recommended for people who are unable to tolerate the bisphosphonates because of kidney disease or intolerable side effects. […] During and after treatment, blood tests are performed every three to six months to check the level of alkaline phosphatase; a falling level is a good indicator that treatment is working. […] People with Paget disease may have pain that is related to pagetic activity in the bone or to related complications. […] The joints adjacent to affected bones may become stiff and painful due to arthritis. Some patients with severe arthritis pain benefit from surgery to replace the joint. […] Most people who plan to have surgery are treated for Paget disease of bone for at least two to three months before surgery.

• #1 Rehabilitation for Paget’s Disease | How Physiotherapy Helps

  https://www.physiotattva.com/blog/rehabilitation-for-pagets-disease-how-physiotherapy-helps

  Pagets disease impacts your bones. This often means that you suffer from pain, stiffness, and general difficulty in managing day-to-day activities. Physiotherapy is an effective way to manage Pagets disease as it offers relief from pain and can strengthen the bones and muscles. […] Here is a list of easy physiotherapy techniques that your physiotherapist may make you perform, based on your condition and treatment plan. […] Improving your overall strength helps you manage your condition better. The bones can get weak or brittle, making them prone to fractures or pain. Strengthening your muscles in and around the region through various exercises and massages can help reduce the intensity of fractures and can reduce pain. […] Manual therapy such as massages, and physical exercises in movement with the assistance of a professional physiotherapist can help improve your bone health. Massages can be stimulating and help reduce inflammation and speed up healing in your muscles and bones.

• #1 Rehabilitation for Paget’s Disease | How Physiotherapy Helps

  https://www.physiotattva.com/blog/rehabilitation-for-pagets-disease-how-physiotherapy-helps

  Joint mobilization techniques help increase the movement in the joint and strengthen the joints. If there is any wear and tear and stiffness, gentle exercises that lead to joint mobilization can help reduce such wear and tear and strengthen bones. […] Pain management techniques such as flexibility exercises, massages, and mind-body activities such as meditation, and breathing exercises can help in pain management. Such activities also help you navigate and locate the pain and manage it better. […] Range of motion exercise helps restore mobility in joints and other parts of the body. These exercises are designed to help reduce stiffness in joints by engaging the muscles, tendons, and bones. This can have a positive impact on the bones and strengthen it. […] Massages are another effective way of managing pain during Paget’s disease. Oil massages and heat massages can help reduce inflammation by providing a soothing effect on the tendons and muscles.

• #1 Paget’s Disease of Bone: Diagnosis, Treatment, and Steps to Take

  https://www.niams.nih.gov/health-topics/pagets-disease-bone/diagnosis-treatment-and-steps-to-take

  Exercise is important because it helps: […] Before starting a new exercise plan, talk with your doctor to avoid stress on bones affected by Pagets disease. […] Fortunately, current treatments can help most people with Pagets disease lead productive lives. When you follow your doctors treatment plan, you may lower the chance of developing complications or major changes in your bones.

• #1

  https://www.nhs.uk/conditions/pagets-disease-bone/

  There’s currently no cure for Paget’s disease of bone, but treatment can help relieve the symptoms. […] The main treatments are: bisphosphonate medication medicines that help control bone regeneration and are used to control pain […] supportive therapies including physiotherapy, occupational therapy and devices such as walking sticks or shoe inserts […] surgery this may be needed if further problems develop, such as fractures, deformities or severe joint damage […] Ensuring you get enough calcium and vitamin D can also help. Some people may need to take supplements.

• #1 Paget Disease of Bone for Primary Care | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0815/p224.html

  Treatment with nitrogen-containing bisphosphonates is recommended in active disease or when risk of complications is possible. […] Nitrogen-containing bisphosphonates are first-line antipagetic agents. A single 5-mg dose of zoledronic acid (Reclast) given intravenously is the treatment of choice if no contraindications exist. […] After successful antipagetic therapy, patients who have complications of Paget disease of bone such as hearing loss, skeletal deformities, and fractures should be treated similarly to the general population. […] Follow-up is required to monitor treatment response in patients who received antipagetic therapy, disease progression in asymptomatic patients who did not receive treatment, and signs of disease recurrence in patients who had been in remission. […] Patients with symptom relapse or persistence or who experience biochemical relapse may be offered retreatment. Response to treatment is usually observed within three months after therapy is started, and retreatment is appropriate if no response occurs within six months.

• #1 Paget disease of bone An update

  https://www.racgp.org.au/afp/2012/march/paget-disease-of-bone

  Intravenous zoledronic acid is therefore probably the treatment of choice, although risedronate and alendronate remain good options for patients who prefer oral therapy, or if facilities for intravenous treatment are not available. […] When treating PDB, oral bisphosphonates are given at high dose for several months and stopped when remission is achieved; treatment should not be continued long term. […] A common side effect of intravenous bisphosphonate treatment is a transient flu-like illness, occurring in one in 4 patients. […] The response to treatment should be monitored by measuring plasma alkaline phosphatase activity periodically (every 3-6 months) until it normalises, and then annually after stopping treatment. […] Nonpharmacological treatments should not be neglected. For example, patients with deformity resulting in leg shortening may benefit from shoe raises or orthotics to assist with pain relief and gait difficulties.

• #1 Paget’s Disease of Bone

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/rheumatology/pagets-disease-of-bone/

  The oral bisphosphonates have the drawback of gastrointestinal side effects, especially esophagitis. They should be taken with 6 to 8 ounces of water and the patient should be in the upright position for at least 30 minutes without other oral intake. There are intravenous bisphosphonate options for the treatment of PDB. In the United States, pamidronate is given as an intravenous infusion. Zoledronic acid is a highly potent bisphosphonate also given as an intravenous infusion. It was shown that a single infusion of zoledronic acid 5 mg produced a more rapid, more complete, and more sustained response in Pagets disease than did daily treatment with risedronate. […] Treatment efficacy can be monitored via clinical and biochemical responses. Effective therapy for PDB results in a reduction in bone turnover, with a substantial decrease in the serum alkaline phosphatase. It is recommended to check the alkaline phosphatase every 3 months for the first 6 months of therapy and thereafter at intervals of every 6 months.

• #1 What is the Best Treatment for Paget’s Disease?

  https://www.footankleaz.com/blog/wellness-prevention/pagets-disease-treatment/

  Calcitonin, a hormone that helps regulate bone formation and calcium levels, is another treatment for Pagets disease of bone. It is typically given as a daily injection under the skin, though a nasal spray form is available in some cases for easier use. Possible side effects may include mild irritation at the injection site or nausea. […] Managing pain is essential in Pagets disease treatment. For mild to moderate bone pain, acetaminophen is often effective for your foot pain in Scottsdale. NSAIDs, like ibuprofen or naproxen, help reduce both pain and inflammation. For severe pain, doctors may prescribe stronger pain relievers for short-term use to provide additional relief. […] Physical therapy plays a key role in managing Pagets disease by strengthening muscles, improving flexibility, and reducing stress on joints. Range-of-motion exercises help maintain flexibility, while strength-building exercises provide support to affected areas. Low-impact activities like walking or swimming also promote mobility without adding strain to the bones and joints.

• #1 Diagnosis and Management of Paget’s Disease of Bone in Adults: A Clinical Guideline

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6522384/

  The guideline was endorsed by the European Calcified Tissues Society, the International Osteoporosis Foundation, the American Society of Bone and Mineral Research, the Bone Research Society (UK), and the British Geriatric Society. […] The GDG noted that there had been a lack of research on patientfocused clinical outcomes in PDB and identified several areas where further research was needed. […] Bisphosphonates are recommended for the treatment of bone pain associated with Paget’s disease. Zoledronic acid is recommended as the bisphosphonate most likely to give a favorable pain response. […] Treatment aimed at improving symptoms is recommended over a treattotarget strategy aimed at normalizing total ALP in PDB. […] Total hip or knee replacements are recommended for patients with PDB who develop osteoarthritis in whom medical treatment is inadequate.

• #1 Paget’s Disease: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/pagets-disease-of-bone-pro

  The objectives of treatment are control of pain and to reduce or prevent disease progression and complications. […] Treatment aimed at improving symptoms is recommended over a treat-to-target strategy aimed at normalising total alkaline phosphatase. […] Specific treatment is required for complications. […] Because of the risk of osteosarcoma, patients should be monitored indefinitely. […] Referral to secondary care is advisable in a patient thought to have pain or deformity so that further assessment can be performed and treatment offered if appropriate. […] Non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol may be effective for pain. […] Anti-resorptive therapy is usually with bisphosphonates. […] Bisphosphonates are recommended for the treatment of bone pain associated with Paget’s disease.

• #1 Paget’s Disease of Bone – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/pagets-disease-of-bone

  In some cases, surgery may be needed to treat the complications of Paget’s disease, including: Bone fractures, Malalignment or deformity of bone, Severe arthritis. […] The surgical procedures used to treat fractures, malalignment, or arthritis in patients with Paget’s disease are similar to those used to treat similar conditions in people with normal bone. […] Surgery may also be needed if an enlarged bone begins to compress nerves, especially in the spine or skull. […] If treatment occurs before major changes in bone occur, the majority of patients with Pagets disease are able to live a normal, active life. When complications do develop, surgical treatment is usually effective in relieving pain and improving function.

• #1 Treatment for Paget’s Disease of the Bone | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/pagets-disease-of-the-bone/treatments.html

  Many people don’t need treatment for Paget’s disease. But even if you don’t need treatment, you will still need to see your doctor on a regular basis from now on. This will let your doctor watch for other problems you might get from the disease, such as arthritis, fractures, or nerve problems. […] Your doctor may prescribe medicine if you have symptoms or if you have no symptoms but you are at risk for other problems from Paget’s disease. Medicine can help reduce the breakdown of bone tissue, control symptoms such as bone pain, and prevent other problems such as arthritis, fractures, or nerve damage. […] Bisphosphonates are usually the first medicines prescribed for Paget’s disease. They often make the disease inactive, sometimes for years or decades. If it becomes active again, you may need to take this medicine off and on to keep the disease under control. […] You might also need other treatments, such as: […] Some people may need surgery to replace a damaged hip or knee joint.

• #2 Paget’s Disease of Bone

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/rheumatology/pagets-disease-of-bone/

  The indications for treatment of PDB include bone pain, bone deformity, extensive skull involvement, hypercalcemia, fractures, neurologic compromise, monostotic disease of a tibia or femur in whom progression is likely, and high-output heart failure. Treatment is also indicated in the presence of moderately active asymptomatic disease, with serum alkaline phosphatase at least 3 to 4 times the upper limit of normal, in patients with disease at sites where complications could occur. […] For patients with moderately active disease before elective surgery on the affected bone(s), prophylactic therapy is also used to reduce hypervascularity and blood loss. Some studies indicate that antipagetic treatment is valuable for symptomatic as well as asymptomatic patients, with the goal of reducing local disease progression and the risk of future complications. In general, because therapy is effective and safe, treatment should be withheld only in asymptomatic patients whose disease is located only in areas with no risk of complications.

• #2 Paget Disease Treatment & Management: Approach Considerations, Bisphosphonates and Calcitonin Analogues, Neoplasm

  https://emedicine.medscape.com/article/334607-treatment

  The short-term objective of Paget disease treatment is to control disease activity. The long-term objectives are to minimize or prevent disease progression and to decrease complications from the disease, if possible. […] Indications for drug treatment of Paget disease are as follows: Metabolic active disease – Bone pain, fatigue fracture, skull/spine fracture, radiculopathy, osteolytic lesions, bony deformities, weight-bearing bone involvement, compression of spinal cord and nerve roots, bone compression of the eighth cranial or optic nerve. […] When Paget disease occurs around a joint, treatment is often administered in an attempt to prevent development of osteoarthritis. In addition, young patients with Paget disease and those with high levels of bone-specific alkaline phosphatase (BSAP) are often treated to avoid future complications.

• #2 Paget’s Disease of Bone | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/pagets-disease-of-bone

  The aim of this guideline was to formulate practice guidelines for the diagnosis and treatment of Paget’s disease of the bone. […] We recommend that plain radiographs be obtained of the pertinent regions of the skeleton in patients with suspected Paget’s disease. […] If the diagnosis is confirmed, we suggest that a radionucleotide bone scan be done to determine the extent of the disease. […] After diagnosis of Paget’s disease, we recommend measurement of serum total alkaline phosphatase or, when warranted, a more specific marker of bone formation or bone resorption to assess the response to treatment or evolution of the disease in untreated patients. […] We suggest treatment with a bisphosphonate for most patients with active Paget’s disease who are at risk for future complications.

• #2 Clinical management | Paget’s Association

  https://paget.org.uk/health-and-research-professionals/clinical-management/

  It is recognised that not everyone with Pagets disease requires treatment, because, in many cases, it causes no symptoms nor complications. Decisions to treat Pagets disease should be made by a specialist, on an individual basis. Specific anti-pagetic treatment involves the use of osteoclast inhibitors to reduce the elevation in bone turnover that is characteristic of active disease. In addition, analgesics, non-steroidal anti-inflammatory drugs, and anti-neuropathic pain agents can be used for symptom control. […] For those who require treatment, the current first-line bisphosphonate, due to its potency and prolonged duration of action, is zoledronic acid. It is the bisphosphonate most likely to relieve pain from active Pagets disease. A single infusion of 5mg can be effective for many years.

• #2 Frequently Asked Questions – Bone Health & Osteoporosis Foundation

  https://www.bonehealthandosteoporosis.org/pagets/pagets-frequently-asked-questions/

  The goal of treatment is to normalize Paget’s disease activity for a prolonged period of time. In general, the therapies of choice are the three more potent bisphosphonates: Actonel™, Fosamax® and Aredia®. Didronel®, Skelid® or Miacalcin® may be appropriate therapies for selected patients. Following is information about all therapies approved by the U.S. Food and Drug Administration (FDA) for the treatment of Paget’s disease: […] Bisphosphonates. Five bisphosphonates are currently available. Four are in tablet form and one is in intravenous form. As a rule, bisphosphonate tablets should be taken on an empty stomach. Specific instructions for taking each drug are included in the chart that follows. Also, an adequate dietary calcium intake (1000-1500 mg daily) and vitamin D intake (400 units) are recommended during bisphosphonate use, except if there is a history of kidney stones containing calcium. The recommended dosages that follow are those approved by the FDA. However, experienced physicians may sometimes prescribe different doses. None of these drugs should be used by people with severe kidney disease.

• #2 Paget Disease Treatment & Management: Approach Considerations, Bisphosphonates and Calcitonin Analogues, Neoplasm

  https://emedicine.medscape.com/article/334607-treatment

  Anderson et al induced biochemical remission with one or more complex courses of pamidronate in 90% of patients with elevated alkaline phosphatase levels. […] In a comparative study, normalization of alkaline phosphatase was achieved in 77% of patients treated with risedronate, compared with 10% using a 400-mg etidronate regimen. […] When given for 12 weeks, a daily regimen of 400 mg of tiludronate reduced alkaline phosphatase activity by 58% at 24 weeks. […] In a randomized, double-blind trial comparing a single intravenous infusion of 5 mg of zoledronic acid with oral administration of 30 mg of risedronate daily for 2 months, normalization of alkaline phosphatase levels was achieved at 6 months in 89% and 58% of patients, respectively. […] A study by Devogelaer and colleagues examining Paget disease remission after treatment with a 5 mg intravenous infusion of zoledronic acid in routine clinical practice found effectiveness and safety data similar to those observed in the original trial populations.

• #2 Paget Disease Treatment & Management: Approach Considerations, Bisphosphonates and Calcitonin Analogues, Neoplasm

  https://emedicine.medscape.com/article/334607-treatment

  These studies have shown that a single infusion of 5 mg of zoledronic acid is associated with a greater percentage of normalization of serum alkaline phosphatase in treated patients and a prolonged biochemical remission with lower relapse rate, making it the most effective therapy available to date.

• #2 Paget’s disease of bone | Causes, symptoms, treatments

  https://versusarthritis.org/about-arthritis/conditions/pagets-disease-of-bone/

  Infusions of bisphosphonates are given in hospital and each one usually takes about 1530 minutes. The advantage of infusions is that all the drug is all absorbed into the body. However, the condition can also be treated with tablets, which you may find more convenient. […] If you cant take bisphosphonates because of side effects, your doctor might suggest daily injections of a drug called calcitonin instead. […] If you have pain resulting from joint damage or pressure on the nerves, then you may also need painkillers such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. […] It may be helpful to see a physiotherapist. […] Surgery isnt usually needed for Pagets disease, but can sometimes be helpful for other problems linked to Pagets disease for example: […] Its important that people with Pagets disease eat a good diet with enough calcium and vitamin D. […] Theres no research to suggest that any form of complementary medicine is helpful for Pagets disease.

• #2

• #2 Paget Bone Disease | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26520

  Denosumab has been used off-label in cases of bisphosphonate intolerance or contraindication, with good results. […] Supplements such as calcium and vitamin D have been known to provide some symptomatic benefits. […] Pain management is usually achieved by either NSAIDs or acetaminophen. […] Surgery is only offered as an option to patients diagnosed with Paget disease with a progression into osteosarcoma. […] Patients with cauda equina and other nerve compression complications will frequently require laminectomy. […] Current endocrine guidelines for Paget disease: Obtain plain x-rays of the affected body part. […] Patients at risk for complications like fractures should be started on bisphosphonates, with alendronate 40 mg daily being the first choice in the oral category. […] Another straightforward treatment option is a single 5 mg dose of intravenous zoledronic acid if there are no contraindications. […] If patients with Paget disease need surgery, one should consider pretreatment with bisphosphonates.

• #2 Paget’s Disease of Bone – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/pagets-disease-of-bone

  Paget’s disease of bone is a chronic disease of the skeleton. […] In most cases, treatment for Pagets disease involves taking medications to help slow or stop the progress of the disease. For patients who have complications, surgery may be needed to realign deformed bones or to help fractures heal. […] There is no cure for Pagets disease and no way to reverse its effects on bone. Treatment focuses on relieving symptoms and preventing future complications. […] If symptoms do occur, your doctor may recommend one or more nonsurgical treatments. […] Medications such as ibuprofen, naproxen, and aspirin can help relieve mild bone pain that arises from Pagets disease or from arthritis that may be associated with the disease. […] When bone pain is more significant, medications called bisphosphonates are the treatment of choice. These drugs block osteoclasts and can be very effective in treating Paget’s disease.

• #2

  https://link.springer.com/article/10.1007/s40618-024-02318-1

  We suggest the use of analgesics, NSAIDs and/or neuropathic agents as integrative treatments when antiresorptives are not able to achieve a satisfactory relieve of the painful symptoms. […] In case of recurrence or worsening of pain symptoms at the level of the pagetic lesions in patients previously treated with antiresorptive therapy, we suggest a new therapeutic course favoring intravenous N-BP regimens (zoledronate and neridronate) in case of previous treatment with calcitonin, non-N-BPs or oral N-BPs.

• #2 Paget’s disease of bone – Wikipedia

  https://en.wikipedia.org/wiki/Paget%27s_disease_of_bone

  As the disease often affects people differently, treatments of Paget’s disease can vary. […] Although there is no cure for Paget’s disease, medications (bisphosphonates and calcitonin) can help control the disorder and lessen pain and other symptoms. Medications are often successful in controlling the disorder, especially when started before complications begin. […] The goal of treatment is to relieve bone pain and prevent the progression of the disease. […] These medications are usually recommended for people with Paget’s disease who: […] Five bisphosphonates are currently available. […] The approved regimen is once daily for six months; a higher dose is more commonly used. […] Medical therapy prior to surgery helps to decrease bleeding and other complications. […] Patients who are having surgery should discuss treatment with their physician. […] In general, patients with Paget’s disease should receive 1000-1500 mg of calcium, adequate sunshine, and at least 400 units of vitamin D daily. […] Exercise is very important in maintaining skeletal health, avoiding weight gain, and maintaining joint mobility.

• #2 Get Paget’s Disease Treatment Online – TeleMed2U

  https://www.telemed2u.com/rheumatology/pagets-disease

  Supplements – vitamin D and calcium is usually recommended in conjunction with some of the medications used for Pagets disease. Some medications have been shown to lower calcium levels and supplements may help offset this and reduce complications associated with pharmacological treatments. […] Surgery – usually required for displaced or severe fractures, severe deformities, or major arthritic changes in the joint from Pagets disease. Internal fixation of hardware, such as screws, may be used for fractures. Osteotomies to reposition deformed bones are another surgical approach for Pagets disease. Lastly, joint replacement surgery may also be required depending on the severity of joint damage from arthritic changes to the joint.

• #2 Paget Disease of Bone – Bone, Joint, and Muscle Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/bone-joint-and-muscle-disorders/paget-disease-of-bone/paget-disease-of-bone

  Calcitonin is occasionally used as an alternative to bisphosphonates in people who cannot take bisphosphonates or do not tolerate them. Calcitonin is injected under the skin or into muscle. […] Doctors encourage weight bearing (such as standing and walking) and discourage excessive bed rest (except for sleeping at night). […] Because bone is being remodeled rapidly, people should consume adequate amounts of calcium and vitamin D in their diet. Vitamin D helps the body absorb calcium and add it to bone (a process called bone mineralization). Vitamin D and calcium supplements are often needed. Otherwise, poor bone mineralization and bone weakening (osteomalacia) may occur.

• #2 Paget’s Disease of the Bone: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/21929-pagets-disease-of-the-bone

  Treatments for Pagets disease of the bone can include: […] Medication: Many medications can treat Pagets disease of the bone. The most common type is bisphosphonates. The most effective bisphosphonate is zoledronate (Reclast). Often, one dose of this drug can result in long-lasting remission of the disease but it cant correct bone deformities. […] Surgery: You might need surgery to fix or improve complications of Pagets disease of the bone. Some surgeries include knee or hip replacements, surgery to realign deformed bone and surgery to enable bone fractures to heal in a better position. […] There’s currently no cure for Pagets disease of the bone, but its treatable. The sooner Pagets disease can be diagnosed and treated, the less likely that youll experience complications from the disease. […] Pagets disease of the bone is a chronic (lifelong) condition but its treatable. It often gets worse slowly over time if it isnt treated.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Treatment-of-Pagets-disease-of-the-bone.aspx

  Drugs used include Alendronate and Etidronate to be taken by mouth every day for 6 months. Tiludronate and Risedronate are also taken as pills daily for 3 months and 2 months respectively. […] Surgical therapy is used mainly to treat the complications of Paget’s disease. It is necessary if there are fractures, compression of surrounding nerves, severe arthritis or alterations in bone alignment. […] Before surgery the patient is treated with bisphosphonates that reduce the risk of excessive bleeding during surgery. […] Bones affected by Paget’s disease may take longer to heal than normal bones. After fractures or a surgery a longer period of immobilization and physical therapy may be necessary for healing.

• #2 Paget disease of bone An update

  https://www.racgp.org.au/afp/2012/march/paget-disease-of-bone

  Pre-operative treatment with bisphosphonates is recommended for patients undergoing elective surgery (such as joint replacement) to bones with metabolically active Paget disease to reduce perioperative bleeding. […] The treatments of choice for PDB are oral alendronate, oral risedronate and intravenous zoledronic acid. […] A key clinical trial demonstrated superiority of a single infusion of intravenous zoledronic acid over a 2 month course of oral risedronate with normalisation of ALP in 89% and 58% of patients respectively, and greater improvements in pain and quality of life in the zoledronic acid group. […] Patients in this trial who achieved remission have been followed up for 6.5 years; relapse has occurred in 0.7% of patients treated with zoledronic acid compared with 20% for risedronate.

• #2

  https://arthritis.ca/about-arthritis/arthritis-types-(a-z)/types/paget-s-disease

  You can also use over-the-counter medications to address the pain from Pagets disease. These include acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs). […] The following healthcare professionals have advanced training and are registered to practice by their respective provincial/territorial colleges: A physiotherapist (PT) can develop an individualized rehabilitation program designed to help you increase your strength, flexibility, range of motion and general mobility and exercise tolerance through a wide variety of therapeutic treatments and strategies. These can help you reduce falls and prevent bone fractures. […] An occupational therapist (OT) can look at your activities of daily living and develop a program to help lessen your symptoms and improve your function. An OT can do a home or workplace assessment to identify ways to protect your joints and can recommend tools and aids to help you conserve energy and improve your independence. For example, this could include use of a cane and raised seats to decrease stress on your hip and knee joints.

• #2 Rehabilitation for Paget’s Disease | How Physiotherapy Helps

  https://www.physiotattva.com/blog/rehabilitation-for-pagets-disease-how-physiotherapy-helps

  Staying active is one of the best ways to manage Pagets Disease. Staying active allows the strengthening of muscles and joints. It also helps reduce the density of bone growth as your body is worked to stay active. […] A healthy and well-balanced diet rich in calcium, protein, and other nutrients helps facilitate bone strengthening and ensures that the muscles are supplied with the right support for recovery and healing. […] Physiotherapy can help manage the conditions of Paget’s disease. It helps restore mobility, improve range of motion, and reduce inflammation and pain.

• #2 Paget’s Disease of Bone | MedlinePlus

  https://medlineplus.gov/pagetsdiseaseofbone.html

  Diet and exercise do not treat Paget’s, but they can help to keep your skeleton healthy. If you do not have kidney stones, you should make sure to get enough calcium and vitamin D through your diet and supplements. Besides keeping your skeleton healthy, exercise can prevent weight gain and maintain the mobility of your joints. Talk with your health care provider before you start a new exercise program. You need to make sure that the exercise does not put too much stress on the affected bones.

• #2

  https://arthritis.ca/about-arthritis/arthritis-types-(a-z)/types/paget-s-disease

  Both PTs and OTs can recommend assistive devices, such as knee braces and hand splints, that can support your joints and protect weaker bones from breaking. […] In some cases, patients with Pagets disease undergo an osteotomy. This is a surgical procedure by which an affected bone is reshaped to correct for bowing or misalignment. Alternatively, some people with Pagets disease may need surgery to replace a badly damaged hip or knee joint. Both surgical options can reduce pain and improve function.

• #2 Paget’s disease of bone: A clinical update

  https://www1.racgp.org.au/ajgp/2021/january-february/pagets-disease-of-bone

  In a Cochrane review, bisphosphonates resulted in a 50.1% greater reduction in total ALP than placebo and were far more likely to normalise the total ALP. […] The duration of the effect on bone turnover is also longer after zoledronic acid than other bisphosphonates. […] This has led to the recommendation that bisphosphonate therapy should be reserved for use in symptomatic PDB and focus on symptom management rather than suppression of bone turnover. […] Denosumab is an alternative antiresorptive therapy used for patients with osteoporosis; however, it has been less studied in PDB than bisphosphonates. […] Treatment response is best assessed by measuring serum total ALP 36 months after treatment and then annually once levels are normalised. […] If symptoms recur and serum ALP rises above the normal range, retreatment with zoledronic acid should be considered. […] Zoledronic acid is highly effective in treating symptomatic disease, with high rates of long-term remission.

• #2 Updates on Paget’s Disease of Bone

  https://www.e-enm.org/journal/view.php?number=2339

  Overall, zoledronate displays an excellent safety profile. […] Despite bisphosphonates being the primary treatment for PDB, disease-related complications may necessitate surgical procedures such as joint replacement, osteotomy for deformity, or the surgical management of fractures. […] Treatment monitoring Antiresorptive drugs reduce the resorption markers more rapidly than formation markers. […] The measurement of P1NP or total and bone-specific ALP and CTX or NTX is indicated for evaluating the activity of untreated monostotic PDB, despite these values being normal during evident disease activity. […] Biochemical follow-up is a more objective indication of relapse than symptoms in patients with an accelerated bone turnover.

• #2 Treatment | Paget’s Association

  https://paget.org.uk/pagets-disease/what-is-pagets-and-how-is-it-managed/treatment/

  Bisphosphonates can also be given as tablets; these are slightly less effective than an infusion of zoledronic acid, at reducing bone remodelling, and the effect doesnt last quite as long. […] The most commonly used oral treatment is 30mg of risedronate sodium, taken daily, for two months. […] Pamidronate is an effective treatment but has largely been superseded by zoledronic acid which lasts longer and is easier to administer. […] In some cases where bisphosphonates are not recommended, calcitonin injections may be considered to treat bone pain in Pagets disease. […] A comprehensive review on the effects of bisphosphonates in the treatment of Pagets disease, published in 2017, concluded that serious side effects were rare and that the most common side effects experienced were a flu-like illness in people given bisphosphonates by infusion, and stomach upset in those given tablets.

• #2 Paget’s disease | Endocrine Conditions

  https://www.yourhormones.info/endocrine-conditions/pagets-disease/

  There may be associated complications that will involve surgery; it may be necessary to repair a fracture, replace a joint damaged by osteoarthritis or to correct very noticeable bone deformity. […] Flu-like symptoms can occur 2448 hours after treatment with zoledronate and can be linked with bone and joint pains. […] Risedronate may cause indigestion and occasional joint and bone pains and, rarely, can give rise to skin rashes and eye inflammation. […] When treating Pagets disease, a multidisciplinary approach should be adopted.

• #2 Paget’s disease of bone: who to treat and why it matters | Endocrinology Today

  https://endocrinology.medicinetoday.com.au/et/2018/february/feature-article/pagets-disease-bone-who-treat-and-why-it-matters

  People with asymptomatic Pagets disease generally do not require treatment; however, if the site of the disease increases the risk of future complications (e.g. vertebral involvement leading to spinal cord compression) then treatment should be considered. […] Treatment with a single infusion of zoledronic acid 5mg is generally safe, long-lasting and effective in resolving bone pain and normalising bone turnover markers.

• #2 Paget’s Disease: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/pagets-disease-of-bone-pro

  The objectives of treatment are control of pain and to reduce or prevent disease progression and complications. […] Treatment aimed at improving symptoms is recommended over a treat-to-target strategy aimed at normalising total alkaline phosphatase. […] Specific treatment is required for complications. […] Because of the risk of osteosarcoma, patients should be monitored indefinitely. […] Referral to secondary care is advisable in a patient thought to have pain or deformity so that further assessment can be performed and treatment offered if appropriate. […] Non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol may be effective for pain. […] Anti-resorptive therapy is usually with bisphosphonates. […] Bisphosphonates are recommended for the treatment of bone pain associated with Paget’s disease.

• #2 Paget’s Disease: What Causes This Chronic Bone Disorder?

  https://www.healthline.com/health/pagets-disease-of-bone

  Surgery: Surgery might be used to treat complications of Pagets disease. This includes surgery for fractures, misshapen bones, or severe arthritis. […] If treated before complications develop, Pagets disease has a good prognosis. Treatment can help those with the condition live a healthy and active life. […] However, Pagets disease of the bone is treatable with medication. Early treatment can prevent complications and maintain quality of life.

• #2 Updates on Paget’s Disease of Bone

  https://www.e-enm.org/journal/view.php?number=2339

  Pagets disease of bone is a prevalent disease characterized by disorganized bone remodeling, but it is uncommon in East Asian countries. […] Bisphosphonates, such as zoledronic acid and pamidronate, are used to treat Paget’s disease of bone. […] Further, bisphosphonates such as zoledronic acid and pamidronate are effective for its treatment. […] The majority of patients have no symptoms and do not require treatment. However, most individuals with active PDB at a risk for further skeletal and extraskeletal problems should be treated with bisphosphonate. […] Patients without contraindications should be administered a single dose of 5 mg intravenous (IV) zoledronate. […] This 6-month study demonstrated that 96% of the patients receiving zoledronate exhibited a therapeutic response, as compared to 74% of those receiving risedronate.

• #3 Paget’s disease of bone: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/177668

• #3 Paget’s disease of bone – Wikipedia

  https://en.wikipedia.org/wiki/Paget%27s_disease_of_bone

  As the disease often affects people differently, treatments of Paget’s disease can vary. […] Although there is no cure for Paget’s disease, medications (bisphosphonates and calcitonin) can help control the disorder and lessen pain and other symptoms. Medications are often successful in controlling the disorder, especially when started before complications begin. […] The goal of treatment is to relieve bone pain and prevent the progression of the disease. […] These medications are usually recommended for people with Paget’s disease who: […] Five bisphosphonates are currently available. […] The approved regimen is once daily for six months; a higher dose is more commonly used. […] Medical therapy prior to surgery helps to decrease bleeding and other complications. […] Patients who are having surgery should discuss treatment with their physician. […] In general, patients with Paget’s disease should receive 1000-1500 mg of calcium, adequate sunshine, and at least 400 units of vitamin D daily. […] Exercise is very important in maintaining skeletal health, avoiding weight gain, and maintaining joint mobility.

• #3 Paget Disease of Bone for Primary Care | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0815/p224.html

  Treatment with nitrogen-containing bisphosphonates is recommended in active disease or when risk of complications is possible. […] Nitrogen-containing bisphosphonates are first-line antipagetic agents. A single 5-mg dose of zoledronic acid (Reclast) given intravenously is the treatment of choice if no contraindications exist. […] After successful antipagetic therapy, patients who have complications of Paget disease of bone such as hearing loss, skeletal deformities, and fractures should be treated similarly to the general population. […] Follow-up is required to monitor treatment response in patients who received antipagetic therapy, disease progression in asymptomatic patients who did not receive treatment, and signs of disease recurrence in patients who had been in remission. […] Patients with symptom relapse or persistence or who experience biochemical relapse may be offered retreatment. Response to treatment is usually observed within three months after therapy is started, and retreatment is appropriate if no response occurs within six months.

• #3 Paget’s disease of bone: who to treat and why it matters | Endocrinology Today

  https://endocrinology.medicinetoday.com.au/et/2018/february/feature-article/pagets-disease-bone-who-treat-and-why-it-matters

  Although the prevalence of Pagets disease is declining, it remains an important clinical entity. […] There are highly successful treatments available for this benign bone disorder, with bisphosphonates the mainstay of treatment. […] Bisphosphonates are highly effective in suppressing bone turnover and are the mainstay of treatment for Pagets disease. […] Zoledronic acid 5 mg given as a single intravenous dose is the preferred drug and usually results in sustained remission and improvement in bone pain. […] Following a diagnosis of Pagets disease, specialist referral of the patient to an endocrinologist is generally recommended if the serum ALP level is elevated or if bone pain is present. […] Therapy should be offered to all patients with bone pain or established complications of Pagets disease.

• #3 Paget’s Disease of Bone

  https://rheumatology.org/patients/pagets-disease-of-bone

  Treatment goals focus on pain control with many common over the counter medications (acetaminophen (Tylenol), ibuprofen (Advil, Motrin) and decrease bone turnover to prevent complications such as fracture. Bisphosphonates are prescription drugs that are currently the treatment of choice having shown to be effective at reducing elevated bone turnover in Pagets disease. Oral bisphosphonates include alendronate (Fosamax), etidronate (Didronel), tiludronate (Skelid) and risendronate (Actonel). […] Drugs administered through the veins or as an injection shot used to treat Pagets disease include pamidronate (Aredia), zoledronate (Reclast), and calcitonin, a hormone. Surgery may be needed to treat arthritis caused by bone changes to ease pain and improve function. Medications for Pagets disease do not treat prior damage already caused by the disease like hearing loss, bone deformities, or osteoarthritis.

• #3 Paget disease of bone An update

  https://www.racgp.org.au/afp/2012/march/paget-disease-of-bone

  Pre-operative treatment with bisphosphonates is recommended for patients undergoing elective surgery (such as joint replacement) to bones with metabolically active Paget disease to reduce perioperative bleeding. […] The treatments of choice for PDB are oral alendronate, oral risedronate and intravenous zoledronic acid. […] A key clinical trial demonstrated superiority of a single infusion of intravenous zoledronic acid over a 2 month course of oral risedronate with normalisation of ALP in 89% and 58% of patients respectively, and greater improvements in pain and quality of life in the zoledronic acid group. […] Patients in this trial who achieved remission have been followed up for 6.5 years; relapse has occurred in 0.7% of patients treated with zoledronic acid compared with 20% for risedronate.

• #3 Paget Disease of Bone – Bone, Joint, and Muscle Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/bone-joint-and-muscle-disorders/paget-disease-of-bone/paget-disease-of-bone

  Calcitonin is occasionally used as an alternative to bisphosphonates in people who cannot take bisphosphonates or do not tolerate them. Calcitonin is injected under the skin or into muscle. […] Doctors encourage weight bearing (such as standing and walking) and discourage excessive bed rest (except for sleeping at night). […] Because bone is being remodeled rapidly, people should consume adequate amounts of calcium and vitamin D in their diet. Vitamin D helps the body absorb calcium and add it to bone (a process called bone mineralization). Vitamin D and calcium supplements are often needed. Otherwise, poor bone mineralization and bone weakening (osteomalacia) may occur.

• #3 Paget Disease Treatment & Management: Approach Considerations, Bisphosphonates and Calcitonin Analogues, Neoplasm

  https://emedicine.medscape.com/article/334607-treatment

  Drug therapy for Paget disease should include bisphosphonate treatment with serial monitoring of bone markers. […] Patients should receive 1000-1500 mg of calcium and at least 400 U of vitamin D daily. This recommendation is especially important in conjunction with bisphosphonate treatments. […] Secondary osteoarthritic pain may be reduced by nonsteroidal anti-inflammatory drugs (NSAIDs) or other nonnarcotic analgesics. […] Orthotic devices, including canes and walkers, may be useful for patients with gait abnormalities resulting from Paget disease that involves the lower limbs. […] Because of the increased risk of malignancy, patients with Paget disease should be monitored indefinitely. Chemotherapy, radiation, or both may be used to treat neoplasms that arise from pagetic bone. Amputation may also be necessary in the presence of a malignant transformation.

• #3 Paget’s disease of bone | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/pagets-disease-of-bone

  Although there is no cure for Paget’s disease of bone, there are treatments available to help you live well and manage your symptoms. […] Medications used to treat Paget’s disease of bone include: […] Bisphosphonates used to slow the progression of Paget’s disease of bone. They help the body control the bone-building process to stimulate more normal bone growth. […] Pain relieving medications (analgesics) and non-steroidal anti-inflammatory drugs (NSAIDs) used to provide temporary pain relief. […] Calcium and vitamin D both important for bone health. You can get calcium through your diet and vitamin D through safe exposure to sunlight. Or talk with your doctor about whether you need to consider taking supplements. […] The following strategies can help you to manage your condition: […] In severe cases, surgery may be required to relieve pinched nerves or bone fractures, or to replace a joint severely affected by arthritis.

• #3

  https://scholars.duke.edu/publication/785662

  Calcium and vitamin D repletion are mandatory with these potent anti-osteoclast therapies to avoid hypocalcemia. […] Acquired resistance to etidronate and pamidronate has been reported in some patients, leading to lesser reductions in bone turnover and shorter periods of remission, but substitution with a different bisphosphonate provides a more robust response.

• #3 Treatment | Paget’s Association

  https://paget.org.uk/pagets-disease/what-is-pagets-and-how-is-it-managed/treatment/

  The decision to give treatment may be modified if you have another medical problem which could be aggravated by bisphosphonates. […] An assessment of the response to treatment should take place between 3 and 6 months after the course of treatment has been completed. […] Although bisphosphonates can help reduce bone pain, some patients require a painkilling drug (analgesic) for maximum pain relief, particularly if there is significant osteoarthritis in major joints. […] Calcium is vital for the development of healthy bones, whilst vitamin D is required to help regulate the way your body uses calcium, and to ensure your bones, muscles and teeth remain strong. […] Surgery may be required to treat complications of Pagets disease such as fractures, osteoarthritis and when bone enlargement is thought to be compressing the nerves in the spine. Prior to surgery, it is usual for bisphosphonate treatment to be administered in the hope that this might reduce blood loss, which can occur in Pagets disease, due to the increased vascularity of affected bone.

• #3 Paget’s Disease of Bone | MedlinePlus

  https://medlineplus.gov/pagetsdiseaseofbone.html

  What are the treatments for Paget’s disease of bone? […] To avoid complications, it is important to find and treat Paget’s disease early. The treatments include: […] Medicines. There are several different medicines to treat Paget’s disease. The most common type is bisphosphonates. They help reduce bone pain and stop or slow down the progress of the disease. […] Surgery is sometimes needed for certain complications of the disease. There are surgeries to […] Allow fractures (broken bones) to heal in a better position […] Replace joints such as the knee and hip when there is severe arthritis […] Realign a deformed bone to reduce the pain in weight-bearing joints, especially the knees […] Reduce pressure on a nerve, if enlargement of the skull or spine injuries effects the nervous system

• #3 Paget’s Disease: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/pagets-disease-of-bone-pro

  A Cochrane review found moderate-quality evidence that bisphosphonates improved pain in people with Paget’s disease of bone when compared with placebo. […] Serial monitoring of alkaline phosphatase is used to monitor the effects of treatment and disease activity. […] Bone deformity, osteoarthritis, pathological fractures and nerve compression may necessitate surgery. […] Bisphosphonates should be used pre-operatively to try to reduce disease activity in order to prevent severe bleeding during surgery. […] Total hip or knee replacements are recommended for patients with Paget’s disease who develop osteoarthritis in whom medical treatment is inadequate.

• #3 Paget’s disease of bone – symptoms, treatments and causes | healthdirect

  https://www.healthdirect.gov.au/pagets-disease-of-bone

  Diet: It is important to maintain a healthy diet. Make sure you get enough calcium in your diet to help keep your bones healthy. Ask your doctor if you need a calcium supplement they may also recommend you see a dietitian for specific nutrition advice. […] Physiotherapy and occupational therapy: Keeping active is very important for your bone health, mobility and strength. However, if your bones are affected by Paget’s disease, they may be weaker and you may not be able to do all types of exercises. It is important you talk to a physiotherapist, exercises physiologist or occupational therapist to learn which exercises are best for you.

• #3 PAGET’S DISEASE OF BONE: SYMPTOMS, DIAGNOSIS, TREATMENT AND MORE | Mya Care

  https://myacare.com/blog/pagets-disease-of-bone-symptoms-diagnosis-treatment-and-more

  Surgery can also alleviate nerve compression and resultant neurological signs, such as peripheral numbness or tingling. […] Physiotherapy is the standard option for pain management, improving bone and muscle strength, and increasing range of motion. Common strategies include strength training, manual therapy, joint mobilization, and exercises to improve range of motion. Low-impact exercises, like walking, swimming, and cycling, are ideal for individuals with Paget’s disease. […] Assistive devices, a healthy diet, and peer support groups are also helpful.

• #3 Patient education: Paget disease of bone (osteitis deformans) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/paget-disease-of-bone-osteitis-deformans-beyond-the-basics

  Synthetic calcitonin is a hormone that is given as an injection under the skin several times a week. Calcitonin may be recommended for people who are unable to tolerate the bisphosphonates because of kidney disease or intolerable side effects. […] During and after treatment, blood tests are performed every three to six months to check the level of alkaline phosphatase; a falling level is a good indicator that treatment is working. […] People with Paget disease may have pain that is related to pagetic activity in the bone or to related complications. […] The joints adjacent to affected bones may become stiff and painful due to arthritis. Some patients with severe arthritis pain benefit from surgery to replace the joint. […] Most people who plan to have surgery are treated for Paget disease of bone for at least two to three months before surgery.

• #3 Treatment of Paget’s Disease of Bone | Reumatología Clínica

  https://www.reumatologiaclinica.org/en-treatment-paget39s-disease-bone-articulo-S2173574312000159

  There are five main indications for surgical treatment: Fractures, Deformity: that cause pain when they are difficult to control or associated with bone fissures, corrected through the use of osteotomy, Pagetic arthropathy: arthroplasty when symptoms are not effectively controlled with medical treatment, Entrapment neuropathies and myelopathies, Cancer. […] Biomarkers of bone turnover indirectly estimate the activity of the disease and are therefore used in the assessment of treatment response in conjunction with the clinical response. […] The need for a new cycle of treatment occurs when there is a new increase of bone remodeling.

• #3 Paget disease of bone An update

  https://www.racgp.org.au/afp/2012/march/paget-disease-of-bone

  Intravenous zoledronic acid is therefore probably the treatment of choice, although risedronate and alendronate remain good options for patients who prefer oral therapy, or if facilities for intravenous treatment are not available. […] When treating PDB, oral bisphosphonates are given at high dose for several months and stopped when remission is achieved; treatment should not be continued long term. […] A common side effect of intravenous bisphosphonate treatment is a transient flu-like illness, occurring in one in 4 patients. […] The response to treatment should be monitored by measuring plasma alkaline phosphatase activity periodically (every 3-6 months) until it normalises, and then annually after stopping treatment. […] Nonpharmacological treatments should not be neglected. For example, patients with deformity resulting in leg shortening may benefit from shoe raises or orthotics to assist with pain relief and gait difficulties.

• #3 Paget’s Disease of Bone | Med Diagnostics Rehab

  https://www.meddiagnosticrehab.co/pagets-disease-of-bone.php

  Patients who are asymptomatic may not require any treatment, but are advised to be proactive in preserving bone health by eating a healthy diet with sufficient levels of calcium and vitamin D, and by exercising regularly to keep their joints mobile. […] When symptoms are present, depending on their severity, one or more of the following medications or surgeries may be necessary: Bisphosphonates (osteoporosis medications), Calcitonin, a hormone to regulate bone metabolism, Surgery to repair fractured or deformed bone, Surgery to relieve nerve compression, Surgery to replace joints damaged by arthritis. […] There are side effects and more serious risks associated with medications used to treat Paget’s disease. Bisphosphonates, such as Fosamax, are often associated with gastrointestinal irritation. These medications also increase the risk of osteonecrosis of the jawbone, and of a rare condition that causes the upper thighbone to crack. The alternative medication prescribed, Calcitonin, may cause unpleasant side effects, such as nausea, facial flushing and irritation at the site of administration.

• #3 Paget’s disease of bone: A clinical update

  https://www1.racgp.org.au/ajgp/2021/january-february/pagets-disease-of-bone

  In a Cochrane review, bisphosphonates resulted in a 50.1% greater reduction in total ALP than placebo and were far more likely to normalise the total ALP. […] The duration of the effect on bone turnover is also longer after zoledronic acid than other bisphosphonates. […] This has led to the recommendation that bisphosphonate therapy should be reserved for use in symptomatic PDB and focus on symptom management rather than suppression of bone turnover. […] Denosumab is an alternative antiresorptive therapy used for patients with osteoporosis; however, it has been less studied in PDB than bisphosphonates. […] Treatment response is best assessed by measuring serum total ALP 36 months after treatment and then annually once levels are normalised. […] If symptoms recur and serum ALP rises above the normal range, retreatment with zoledronic acid should be considered. […] Zoledronic acid is highly effective in treating symptomatic disease, with high rates of long-term remission.

• #3 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Treatment-of-Pagets-disease-of-the-bone.aspx

  Pagets disease is a bone disorder that is commonly inherited genetically. Treatment of the condition may include non-surgical therapies, periodic X-rays and so forth. […] These therapies are targeted towards decreasing symptoms of the disease. This includes alleviation of bone pain. Medications, however, fail to reverse the effects on the bone. For patients who have mild pain from the disease or from arthritis associated with it, nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin can be very helpful. […] Regular observation or monitoring of disease progression is recommended for most patients. Periodic X-rays may be recommended for these patients. […] For more severe cases medications of the class bisphosphonates are the treatment of choice. These drugs act by blocking the osteoclasts and prevent bone breakdown caused by them.

• #3 Patient education: Paget disease of bone (osteitis deformans) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/paget-disease-of-bone-osteitis-deformans-beyond-the-basics/print

  Paget disease of bone is a disorder of an aging skeleton in which some bones grow abnormally, affecting their size and shape. […] Many patients with Paget disease do not have symptoms and do not need treatment. However, treatment may be recommended to decrease the risk of future complications, even if the person has no current symptoms. This may include people who have involvement of the skull, spine, or lower limbs. […] Patients who have pain, bone deformities, or other symptoms related to Paget are usually treated with medications that stop the abnormal bone turnover. The treatment of choice is a bisphosphonate. […] Bisphosphonates inhibit the breakdown and removal of bone by inhibiting the osteoclast. The nitrogen-containing bisphosphonates include alendronate, risedronate, pamidronate, and zoledronic acid.

• #4 Clinical management | Paget’s Association

  https://paget.org.uk/health-and-research-professionals/clinical-management/

  Risedronate is also an effective treatment and is given orally once a day, 30mg for 2 months. Risedronate also helps relieve pain from active Pagets disease with effects that can last for 2 years or more. The duration of effect is not as long as that of zoledronic acid. […] Pamidronate is an effective treatment but has largely been superseded by zoledronic acid. Pamidronate is given in several doses, intravenously and repeated when necessary, depending on symptoms. Doses can vary, but commonly 60mg is given by an infusion and this is repeated on 3 consecutive days. […] In cases where bisphosphonates are not recommended, calcitonin injections may be considered to treat bone pain in Pagets disease. […] Bisphosphonates are recommended for the treatment of bone pain associated with Pagets disease. Zoledronic acid is recommended as the bisphosphonate most likely to give a favourable pain response.

• #4 Paget’s disease of bone: A clinical update

  https://www1.racgp.org.au/ajgp/2021/january-february/pagets-disease-of-bone

  Most cases of PDB are diagnosed incidentally on radiographs or as an isolated elevation of serum alkaline phosphatase. […] The mainstay of treatment for PDB is bisphosphonate therapy, with zoledronic acid being the most effective agent. A single infusion of zoledronic acid leads to a sustained reduction in bone pain and markers of bone turnover. […] While all bisphosphonates have been shown to be effective in PDB, zoledronic acid is most effective. […] The treatment of choice for PDB is bisphosphonates, which are highly effective at suppressing the accelerated bone turnover by directly inhibiting osteoclasts. […] A randomised open-label trial comparing zoledronic acid with pamidronate that recruited 89 participants showed that a single intravenous infusion of 4 mg zoledronic acid was more likely to give pain relief than 30 mg pamidronate when given on two consecutive days every three months.

• #4 Treatment | Paget’s Association

  https://paget.org.uk/pagets-disease/what-is-pagets-and-how-is-it-managed/treatment/

  If an affected bone fractures (breaks), an operation is usually necessary to stabilise the fracture. […] When Pagets disease leads to marked damage of the joints (osteoarthritis) and if symptoms and disability from this become severe, joint replacement surgery may be required. […] If nerve compression occurs, surgery may be necessary, e.g. Pagets disease in the spine can press on the spinal cord, causing a narrowing that occasionally needs to be corrected surgically, if medical treatment is unsuccessful.

• #4 Patient education: Paget disease of bone (osteitis deformans) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/paget-disease-of-bone-osteitis-deformans-beyond-the-basics/print

  Zoledronic acid is given as an infusion into a vein over 15 to 20 minutes. It is the preferred drug for treatment because it is generally well-tolerated and offers patients a prolonged remission of Paget’s disease. […] Alendronate and risedronate are also effective. These medications are pills taken daily by mouth for two to six months. […] Pamidronate is an older, less potent bisphosphonate that is also effective in many patients with Paget disease. It is given as an infusion into a vein over two to four hours. […] Synthetic calcitonin is a hormone that is given as an injection under the skin several times a week. Calcitonin may be recommended for people who are unable to tolerate the bisphosphonates because of kidney disease or intolerable side effects. […] During and after treatment, blood tests are performed every three to six months to check the level of alkaline phosphatase; a falling level is a good indicator that treatment is working.

• #5 Paget’s disease of bone: when and why to refer to specialist care | British Journal of General Practice

  https://bjgp.org/content/70/700/561

  Referral to secondary care is advisable in a patient thought to have pain or deformity due to PDB so that further assessment can be performed and treatment offered if appropriate. […] Bisphosphonates are the treatment of first choice and are indicated in patients with pain localised to an affected site with evidence of increased metabolic activity. […] In the UK, three bisphosphonates have marketing authorisation for the treatment of PDB. […] Zoledronic acid (ZA) is the treatment of first choice because it is most likely to improve pain and has sustained inhibitory effects on disease activity. […] Intravenous pamidronate is also an effective treatment but is now used less commonly. […] For patients who are not keen on an infusion, oral risedronate represents a good alternative. […] Calcitonin (100 units three times weekly, by subcutaneous injection) is reserved for the management of bone pain where bisphosphonates are contraindicated because long-term treatment has been associated with an increased risk of certain types of cancer. […] Although bisphosphonates can improve bone pain significantly in PDB, many patients require additional analgesics to control the elements of pain that may not be due to increased metabolic activity.

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