Paget disease of bone: therapeutic options

Paget disease of bone is a disorder of unknown etiology involving disturbances in bone remodeling, typically leading to bone pain and other complications such as skeletal deformities, fractures, hearing loss, and neurologic complications. Bisphosphonates (BPs), both oral and intravenous, have improved Paget treatment by reducing and normalizing bone turnover, as measured by biochemical markers and by alleviating symptoms. Six BPs are currently approved by the US Food and Drug Administration (FDA) for the treatment of Paget disease, and each has unique characteristics, such as response rates and requirements for dosage and administration, relevant to clinical outcome. This review provides an overview of these agents-including oral drugs such as alendronate and risedronate, and the intravenous agent zoledronic acid-and briefly discusses other options for managing Paget disease and monitoring treatment efficacy.