Consensus statement on the modern therapy of Paget's disease of bone from a
Western Osteoporosis Alliance symposium. Biannual Foothills Meeting on
Osteoporosis, Calgary, Alberta, Canada, September 9-10, 2000.
Author(s): Drake WM, Kendler DL, Brown JP.
Affiliation(s): Department of Medicine, University of British Columbia, Vancouver, Canada.
will_drake@canada.com
Publication date & source: 2001, Clin Ther. , 23(4):620-6
BACKGROUND: Bisphosphonate therapy remains the most effective way of controlling
Paget's disease of bone (PD). Along with salmon calcitonin, etidronate has been
the mainstay of therapy for approximately 20 years. However, the advent of newer
bisphosphonates with different molecular actions on osteoclasts warrants a
reevaluation of optimal treatment.
OBJECTIVE: At a symposium of the Western Osteoporosis Alliance, physicians with
experience in the management of PD met to review currently available information
and generate this consensus statement as a guideline for clinicians and a source
of information for health care payers.
METHODS: All available randomized, double-blind, controlled studies that compared
the efficacy of newer bisphosphonates with that of etidronate in the treatment of
PD were identified through a search of MEDLINE using the terms Paget's disease,
bisphosphonates, pamidronate, etidronate, alendronate, risedronate, tiludronate,
clodronate, calcitonin, and salmon calcitonin. Because no such studies have been
conducted for pamidronate, clodronate, or calcitonin, these drugs were not
included in the analysis.
CONCLUSIONS: The consensus of the symposium was that etidronate has little place
in the modern management of PD. Newer bisphosphonates such as alendronate and
risedronate provide significant therapeutic advantages over etidronate, both in
the extent of reduction in bone-specific alkaline phosphatase (BSAP) and/or total
serum alkaline phosphatase (SAP) and in the duration of remission, as measured by
normalization of BSAP/SAP. In the absence of a direct comparison between
alendronate and risedronate in the treatment of PD, physician choice is likely to
be based on personal experience, relative cost, and differences in dosing.
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