Treatment
Indications
Î The ES recommends treatment with a bisphosphonate (see Table 2)
for most patients with active Paget's disease who are at risk of future
complications. (1|⊕⊕⊕
)
Choice of Medication
Î The ES suggests a single 5-mg dose of IV zoledronate as the treatment of
choice in patients without contraindications. (2|⊕⊕⊕
)
Assessing the Response to Treatment
Î If there is urgency in the control of symptoms or the disease is
particularly active, the ES suggests the use of short-term response of
bone resorption markers before and shortly after treatment to indicate
that an adequate therapeutic response is likely. (2|⊕⊕
)
Î The ES suggests that patients who have osteolytic lesions of Paget's
disease have a repeat x-ray approximately 1 year after radiological
diagnosis to determine whether there has been improvement with therapy
or worsening in the absence of therapy. Subsequent x-rays may be
considered in the event of persistent elevations of biochemical markers
of bone turnover or the presence of bone pain and to determine when
there is resolution of the lesion. (2|⊕⊕
)
Maintaining Remission
Î The ES suggests that to maximize the duration of remission, bone
turnover should be reduced below the midpoint of the reference range for
the chosen monitoring bone turnover marker. (2|⊕⊕
)
Relapse and Retreatment
Î The ES recommends that in patients with increased bone turnover,
biochemical follow-up should be used as a more objective indicator of
relapse than symptoms. (1|⊕⊕⊕
)
Monostotic Paget's Disease
Î The ES suggests that amino-terminal propeptide of type 1 collagen
(P1NP) or bone-specific ALP (BSAP) and βC-terminal propeptide of
type 1 collagen (βCTx) or N-terminal propeptide of type 1 collagen (NTx)
should be used for assessing the activity of untreated monostotic Paget's
disease, although these may be normal when evidence of disease activity
is still clearly demonstrated on scintigraphy. (2|⊕⊕
)
