Treatment of Pagets disease

The majority of patients require no treatment for the disease. If necessary, pain can be treated with NSAIDs. If bone pain is severe or if the patient has neurological symptoms, or fractures that will not heal, calcitonin or bisphosphonates may be indicated. 

Calcitonin is the natural hormone that inhibits the activity of osteoclasts (see Chapter 6). Produced either from pigs or salmon or more recently from human sources by recombinant DNA technology, it is given daily by sub-cutaneous injections. Calcitonin is the preferred treatment in severe Paget s disease. 

Side effects of calcitonin are nausea, vomiting and diarrhoea together with flushing, paraesthesia and a peculiar taste in the mouth. 

The mechanism of action of bisphosphonates is not completely understood. They are deposited in place of normal bone and may slow bone turnover because they are resistant 

---

Paget disease of bone For treatment of Paget disease of bone where alkaline phosphatase is at least 2 times the upper limit of normal, or those who are symptomatic or at risk for future complications from their disease (alendronate, risedronate, tiludronate) treatment of symptomatic Paget disease (etidronate) treatment of moderate to severe Paget disease (pamidronate). 

---