Paget's disease of bone--current thinking and management

The objective of this article was to critically review the current knowledge on Paget's disease of bone, focusing primarily on possible etiologies and trends in management. Current courses of treatment are described, including calcitonin, diphosphonate and mithramycin therapy and the efficacy of each drug regime is analyzed. Finally, newer, more experimental pharmaceutical agents, such as gallium nitrate, are described.

Information was obtained from English language medical and scientific journals and medical/physiology text books. Index Medicus (1983-1989) and MEDLINE computerized data base were used. Paget's disease of bone, paramyxovirus, osteoclast, calcitonin and diphosphonate were the terms indexed directly. Key authors indexed included Rebel, Baste and Paget. Further information was obtained from the National Association for the Relief of Paget's Disease (England).

Current research focuses primarily on histological and hybridization studies over the past 15 yr in favor of a slow virus as the causative agent in the disease, and the evidence supporting this is analyzed in some detail. In particular, the discovery of nuclear and cytoplasmic inclusion bodies within the osteoclasts of patients with Paget's disease and their similarity to respiratory syncytial virus and measles virus are discussed. Some form of environmental or physiological trigger may be involved, but the exact mechanism remains obscure. The current treatment of Paget's disease is based around the prevention of bone resorption using various diphosphonates and calcitonins, but many of these are associated with severe side effects. Newer pharmaceutical agents to control bone turnover, including gallium nitrate, have given promising results in preliminary medical trials.