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Paget's Disease of Bone

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Diagnosis Table 1. Symptoms and Complications of Paget's Disease of Bone System Complication Musculoskeletal • Bone pain • Bone deformity • Osteoarthritis of adjacent joints • Acetabular protrusion • Fractures • Spinal stenosis Neurological • Hearing loss • Tinnitus • Cranial nerve deficits (rare) • Basilar impression • Increased cerebrospinal fluid pressure • Spinal stenosis • Paraplegia, quadriplegia, vascular steal syndrome Cardiovascular • Congestive heart failure • Increased cardiac output • Aortic stenosis • Generalized atherosclerosis • Endocardial calcification Metabolic • Immobilization ▶ Hypercalciuria ▶ Hypercalcemia • Hyperuricemia • Nephrolithiasis Neoplasia • Sarcoma (osteosarcoma, chondrosarcoma, and fibrosarcoma) • Giant cell tumor Table 2. Recommended Bisphosphonate Dosing Regimens Drug Dosage a Alendronate • 40 mg/d PO for 6 mo. • Retreatment may be required between 2 and 6 y. Risedronate • 30 mg/d PO for 2 mo. • Retreatment may be required between 1 and 5 y. Zoledronate b • 5 mg given as a single IV infusion over 15 min. • Retreatment is seldom required within 5 y. a Vitamin D deficiency should be corrected before administration of these drugs. b e authors recognize that the official generic name for this drug is "zoledronic acid." However, that is a misnomer. In fact, it is the sodium salt, not the acid, that is used in medical practice. erefore, we have elected to use "zoledronate," which is consistent with the nomenclature for bisphosphonates. Brand names: alendronate (Fosamax ® ), risedronate (Actonel ® ), zoledronate (Reclast ® ). Treatment

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