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
