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Feature Article

Diagnosis and current management of Paget’s disease of bone

Mark A Kotowicz

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Abstract

Paget’s disease of bone is the most common metabolic bone disorder after osteoporosis. The potent new bisphosphonates offer opportunities to suppress disease activity and may have a role in reducing associated morbidity – even in asymptomatic patients.

Key Points

  • Paget’s disease affects about 5% of the overall population with a slight male predominance. Between 12 and 40% of patients with Paget’s disease of bone have at least one affected first degree relative.
  • Measurement of total serum alkaline phosphatase is a simple and sensitive screening test that can also be used to monitor therapy. Screening should be considered in family members with unexplained musculoskeletal symptoms.
  • In asymptomatic individuals, Paget’s disease may be diagnosed either as a result of an elevated alkaline phosphatase finding or as an incidental finding on radiographs.
  • Bisphosphonate therapy is now regarded as the treatment of choice for symptomatic patients. Potent oral agents taken for three to six months produce long term suppression of disease activity.
  • Symptomatic disease and preparation for orthopaedic surgery are major indications for bisphosphonate therapy, with potent oral agents offering the potential to modify the course of the disease.
  • Asymptomatic individuals who have involvement at sites that may be prone to complications should be referred for an opinion regarding use of antiresorptive therapy.

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