[Non-hormonal drug treatment in Paget's disease]

The activity of a therapeutic drug against Paget's disease is judged by a reduction in the level of hydroxyprolinuria and of alkaline phosphatasaemia, these being the metabolic signs of the bone changes, and by a decrease in bone pain which may accompany the bone changes in Paget's disease. The effect of aspirin is only moderate and is produced only with large doses that are often not well tolerated. The cortisone drugs are also active only at high doses that should be avoided. The action of sodium fluoride is uncertain. Mithramycin is always effective; it leads to a decrease in the levels of hydroxyprolinuria and of alkaline phosphatosaemia and to disappearance of the pain. At the dose levels used by the authors, mithramycin induces only certain metabolic anomalies (rise in transaminases, decrease in the prothrombin level...) which return to normal at the end of treatment. However, the long-term tolerance of mithramycin is unknown and the authors think that its use in cases of Paget's disease should be severely restricted. Sodium etidronate, a diphosphonate that inhibits both bone resorption and osteoformation also decreases regularly the levels of hydroxyprolinuria and of alkaline phosphatasemia and often decreases the pain. It is usually well tolerated. However at the dose rate of 20 mg/kg/day it may lead to the development of osteomalacia.