[A single infusion of Pamidronate (APD) in Paget's disease of bone]

Bisphosphonates are strong inhibitors of bone resorption and have become the treatment of choice of Paget's disease of bone. Second generation compounds such as amino-hydroxypropylene bisphosphonate (Pamidronate or APD) have not been found to impair bone mineralization, but to induce sustained remission of Paget's disease after short or medium courses. Gastrointestinal side effects may limit compliance. Therefore, 11 patients with mild but symptomatic Paget's disease of bone were treated with APD administered as a single intravenous infusion of 60 mg over 24 hours. The follow-up, with clinical and biochemical evaluations, was between 6 months and one year. Clinical improvement and normalization of biochemical parameters were observed in all patients. On average, plasma alkaline phosphatase activity fell progressively and significantly from 256 +/- 29 U/l (means +/- SEM) to 97 +/- 6 U/l after 6 months and to 102 +/- 11 U/l after one year (normal less than 120 U/l). Urinary excretion of hydroxy-proline decreased within 7 days to normal (from 4.3 +/- 0.5 mumol/lGF to 1.7 +/- 0.2 mumol/lGF, normal less than 2.2). Thereafter it remained within the normal range until one year later (1.8 +/- 0.2 mumol/lGF after 6 months and 1.9 +/- 0.3 mumol/lGF after 1 year). Side effects were negligible, with only a transient increase in body temperature in 2 patients. When bone scintigraphy was repeated after 6 months it revealed a marked decrease in the activity of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)