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Paget's Disease of Bone

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Management of the Complications of Paget's Disease Hearing Loss Î The ES suggests treatment with a potent bisphosphonate to prevent worsening of a hearing deficit. (2|⊕⊕ ) Osteoarthritis Î The ES suggests the use of analgesics as adjunctive therapy for mild-to- moderate joint pain due to joint cartilage deterioration in patients with Paget's disease adjacent to the painful joint. (2|⊕⊕ ) Î For patients with severe osteoarthritis adjacent to Paget's disease of bone, the ES suggests bisphosphonate therapy before undergoing elective total joint replacement to prevent intraoperative hemorrhaging and postoperative loosening of the prosthesis. (2|⊕⊕ ) Bowing of Lower Extremity Î The ES suggests treatment with a potent bisphosphonate before elective surgery for patients who require an osteotomy to correct severe bowing of the lower extremity associated with impaired ambulation and/or severe joint pain. (2|⊕⊕ ) Paralysis Î In cases of paraplegia associated with Paget's disease of the spine, the ES suggests immediate treatment with a potent IV bisphosphonate associated with neurosurgical consultation. Surgical intervention may not be necessary after effective medical treatment unless there is severe structural damage. (2|⊕⊕ ) Neoplasms Î The ES suggests that patients with osteosarcoma or a giant cell tumor be evaluated by an orthopedic surgeon (ungraded recommendation). If surgery is planned, the ES suggests pretreatment with a potent bisphosphonate to reduce bleeding from adjacent pagetic bone. (2|⊕⊕ ) Congestive Heart Failure Î The ES suggests treatment with a bisphosphonate in patients with Paget's disease and congestive heart failure. (2|⊕⊕ )

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