The treatment of Paget ’ s disease of bone Mini - review

The primary objective of Paget’s disease treatment is the relief of symptoms, but treatment is also commonly prescribed to prevent the development of late complications in asymptomatic subjects with active disease (i.e., above normal serum alkaline phosphatase [bALP]). An aggressive course of treatment is recommended before surgery at the site of a pagetic lesion, the aim being to reduce as much as possible the vascularity of the lesion. Bisphosphonates are considered the therapy of choice and the only realistic therapeutic option. All the new bisphosphonates (tiludronate, clodronate, pamidronate, alendronate, risedronate, ibandronate and zoledronate) appear to provide equivalent benefits. The degree of suppression of disease activity and the proportion of patients in whom normalisation of bALP is achieved does not depend on the potency of the individual compounds, but rather on the dose administered and the duration of the treatment. With these drugs, complete and sustained suppression of Paget’s activity is achieved in 80% of patients.