Paget's disease with osteolytic lesions: combining medical and surgical treatments

A patient with extensive Paget's disease of bone presented with severe bone pain, hypercalcaemia and a large osteolytic lesion of the femur which developed during long-term therapy with etidronate. Treatment with pamidronate normalized serum calcium concentration and induced a complete biochemical remission. The osteolytic lesion was grafted with bone chips. A recurrence of the Paget's disease was associated with clear autonomous hypercalcaemic hyperparathyroidism. Five years after removal of 3 1/2 hyperplastic parathyroid glands, the patient remains in complete clinical and biochemical remission. These findings illustrate the pitfalls encountered in the management of Paget's disease and the value of combining medical and surgical interventions.