The list of treatments mentioned in various sources for Paget's disease of bone includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.
The first step in getting correct treatment is to get a correct diagnosis. Differential diagnosis list for Paget's disease of bone may include:
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Some of the different medications used in the treatment of Paget's disease of bone include:
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Primary treatment consists of drug therapy and includes one of the following:
❑ Calcitonin (subcutaneously or intranasally) is used to retard bone resorption (which relieves bone lesions) and reduce levels of serum alkaline phosphate and urinary hydroxyproline secretion. Although calcitonin therapy requires long-term maintenance, improvement is noticeable after the first few weeks of treatment.
❑ Bisphosphonates, such as etidronate, alendronate, pamidronate, tiludronate, and risedronate, produce rapid reduction in bone turnover and relieve pain. They also reduce serum alkaline phosphate and urinary hydroxyproline secretion. Therapy produces noticeable improvement after 1 to 3 months.
❑ Plicamycin, a cytotoxic antibiotic, is used to decrease calcium, urinary hydroxyproline, and serum alkaline phosphatase. It produces remission of symptoms within 2 weeks and biochemical improvement in 1 to 2 months. Plicamycin is used to control the disease and is reserved for severe cases with neurologic compromise and for those resistant to other therapies. However, it may destroy platelets or compromise renal function.
Orthopedic surgery is used to correct specific deformities in severe cases, reduce or prevent pathologic fractures, correct secondary deformities, or relieve neurologic impairment. Joint replacement is difficult because bonding material (methyl methacrylate) doesn’t set properly on pagetic bone.
Other treatment varies according to symptoms. Analgesics or nonsteroidal anti-inflammatory drugs may be given to control pain.
Source: Professional Guide to Diseases (Eighth Edition), 2005
If the patient is asymptomatic, treatment isn’t needed. The patient with symptoms requires drug therapy, which may include:
❑ calcitonin (a hormone, given subcutaneously or I.M.) and etidronate (oral) to retard bone resorption (which relieves bone lesions) and reduce serum ALP and urinary hydroxyproline secretion. Although calcitonin requires long-term maintenance therapy, improvement is noticeable after the first few weeks of treatment; etidronate, a bisphosphonate, produces improvement after 1 to 3 months. Other bisphosphonates include alendronate, pamidronate, risedronate, and tiludronate.
❑ mithramycin, a cytotoxic antibiotic, to decrease urinary hydroxyproline and serum calcium, and ALP levels. This drug produces remission of symptoms within 2 weeks and biochemical improvement in 1 to 2 months. However, mithramycin may destroy platelets or compromise renal function.
Self-administration of calcitonin and etidronate helps patients with Paget’s disease lead near-normal lives. Nevertheless, these patients may need surgery to reduce or prevent pathologic fractures, correct secondary deformities, or relieve neurologic impairment.
To decrease the risk of excessive bleeding due to hypervascular bone, drug therapy with calcitonin and etidronate or mithramycin must precede surgery. Joint replacement is difficult because bonding material (methylmethacrylate) doesn’t set properly on pagetic bone.
Other treatments vary according to symptoms. Aspirin, indomethacin, or ibuprofen usually control pain.
Source: Handbook of Diseases, 2003
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