Paget's disease of bone: updates for clinicians

Area of Science:

• Bone Metabolism and Disease
• Endocrinology
• Rheumatology

Background:

• Paget's disease of bone involves focal increased bone remodeling, leading to lesions and poor bone quality.
• Patients may present with bone pain or be asymptomatic, detected via elevated alkaline phosphatase.
• Diagnosis relies on imaging, including plain films and radionuclide bone scans.

Purpose of the Study:

• To offer clinicians an overview of Paget's disease diagnosis, treatment, and management.
• To compare recent guideline recommendations from the Endocrine Society (2014) and a joint review (2019).

Main Methods:

• Review of current literature and clinical guidelines.
• Comparison of diagnostic and therapeutic strategies between major endocrinology and bone societies.

Main Results:

• Radionuclide bone scans are key for assessing disease extent.
• Bisphosphonates are the primary therapy, effectively reducing bone pain.
• A single 5mg IV dose of zoledronic acid is the current standard treatment.

Conclusions:

• Zoledronic acid typically achieves long-term suppression of bone turnover and pain relief.
• Bisphosphonate therapy is generally recommended for Paget's disease.
• Further evidence is needed on treatment efficacy for other Paget's complications.