Paget's disease of bone: Treatments

Bisphosphonate promotes the healing of osteolytic lesions and improves the histological features of the bone, so some clinicians believe that bisphosphonates should be prophylactically applied to prevent complications in young patients. However, there is a lack of data on whether this approach improves the long-term outcome. There is also insufficient data on whether maintaining ALP levels in the normal range reduces the risk of complications. In the 2009 PRISM study, bone pain control and maintenance of ALP normal range were compared between symptomatic treatment group and intensive bisphosphonate treatment group. In the group receiving symptomatic treatment alone, 50% maintained normal ALP for 2-4 years, and in the intentive treatment group, 80% could maintain normal ALP. However, there was no significant difference in rate of fractures, orthopedic procedure, and quality of life between the two groups. In the intensive treatment group, follow-up studies were performed in patients with normal ALP using zoledronic acid, which showed better quality of life scores and more prolonged suppression of alkaline phosphatase levels, but not in the complication section.
The Bone Research Society of the United Kingdom has proposed a guideline for Paget's disease management. The only indication for antiresorptive therapy to obtain the clinical benefit of Paget's disease is bone pain caused by increased metabolic activity.

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