[Current options for the treatment of Paget's disease of bone]

From 10 to 20% of patients with Paget's disease of bone, including those without patent clinical signs, risk severe neurological, orthopedic or cardiovascular complications. Calcitonin and etidronate were the first drugs allowing a certain degree of control over excessive bone remodeling subsequent to Paget's disease. Further progress has been made with a family of new bisphosphonates (clodronate, pamidronate, tiludronate, alendronate, risedronate, and others). Ideally, treatment should eliminate bone pain, normalize markers, restore normal bone structure, and prevent recurrence and complications. The new generation of bisphosphonates have powerful anti-osteoclasic activity. These easy-to-administer well-tolerated drugs may be indicated in certain asymptomatic patients in the 50-year age range who have active disease and lesions involving the skull (neurological risk) or lower limbs (orthopedic risk). Although there are no data on the cost effectiveness comparing medical or surgical treatment in these forms having reached the stage of complications, the result in terms of pain relief and improved quality of life is real. Further assessment of wider indications for certain non-symptomatic, but threatening forms of the disease, is needed. Prospective studies should focus on medical improvement, quality of life, and cost-effectiveness.