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Paget's disease of bone

E S Siris1

  • 1Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.

Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research
|July 14, 1998
PubMed
Summary

Paget's disease of bone involves abnormal bone remodeling by large osteoclasts. New therapies, like bisphosphonates, offer improved treatment for this complex bone disorder.

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Area of Science:

  • Bone biology and skeletal disorders

Background:

  • Paget's disease of bone is a localized bone remodeling disorder characterized by increased osteoclast activity, leading to altered bone architecture.
  • The etiology is multifactorial, with suspected genetic and environmental factors, including potential paramyxovirus infection in osteoclasts.
  • Disease presentation varies based on affected sites and bone turnover rates.

Purpose of the Study:

  • To review recent advancements in understanding the etiology of Paget's disease.
  • To discuss the development and efficacy of novel therapeutic agents.
  • To highlight shifts in management philosophy for Paget's disease.

Main Methods:

  • Review of recent research on Paget's disease etiology, including genetic and viral investigations.
  • Analysis of data on the effectiveness of newer bisphosphonate therapies.
  • Evaluation of current treatment guidelines and management strategies.

Main Results:

  • Evidence suggests a combination of genetic predisposition and environmental factors, possibly viral, contribute to Paget's disease.
  • Potent bisphosphonates (pamidronate, alendronate, risedronate) normalize bone turnover in most patients, leading to improved bone architecture.
  • Newer bisphosphonates result in normal lamellar bone patterns with rare mineralization defects.

Conclusions:

  • Advances in understanding Paget's disease etiology are emerging, with genetic and environmental factors playing a role.
  • Bisphosphonates represent a significant therapeutic advance, enabling effective normalization of bone turnover.
  • An aggressive treatment approach is now recommended for both symptomatic and high-risk asymptomatic Paget's disease.

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