Pharmacotherapy of Paget's Disease of Bone: Focus on Zoledronic Acid

2009 ◽  
Vol 1 ◽  
pp. CMT.S1095
Author(s):  
Konstantinos Tziomalos ◽  
Vasilios G. Athyros ◽  
Asterios Karagiannis
Keyword(s):  
Zoledronic Acid ◽  
Serum Alkaline Phosphatase ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Paget’S Disease Of Bone ◽  
Principal Characteristic ◽  
Paget's Disease Of Bone ◽  
Osteoclastic Activity ◽  
Therapeutic Decisions ◽  
Increased Risk

Paget's disease of bone (PDB) affects 1%-3% of the population and is associated with increased risk for bone fracture and deformity. Increased osteoclastic activity is the principal characteristic of PDB. Bisphosphonates inhibit osteoclastic activity and represent the mainstay of treatment of PDB. Zoledronic acid, a potent member of this class, normalizes serum alkaline phosphatase (ALP) levels in the majority of patients with PDB and induces sustained disease remissions. It appears to be more effective than both risedronate and pamidronate. However, it is not clear whether bisphosphonates, including zoledronic acid, improve the clinical outcome of patients with PDB. Zoledronic acid was associated with increased risk for atrial fibrillation and osteonecrosis of the jaw in some studies in patients with osteoporosis and cancer, respectively, but not in patients with PDB. Until we have data on the effects of bisphosphonates on clinical outcomes in PDB such as fracture, deformity and osteosarcoma, we must base therapeutic decisions on the data regarding the effects of these agents on disease activity markers (such as serum ALP levels) and bone pain.

Paget’s disease of bone

2013 ◽  
Author(s):  
Stuart H. Ralston
Keyword(s):  
Bone Turnover ◽  
Viral Infections ◽  
Serum Alkaline Phosphatase ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Bisphosphonate Therapy ◽  
Paget’S Disease Of Bone ◽  
Bone Architecture ◽  
Paget's Disease Of Bone ◽  
Disease Extent

Paget's disease of bone (PDB) affects up to 1% of people of European origin aged 55 years and above. It is characterized by focal abnormalities of bone remodelling which disrupt normal bone architecture, leading to expansion and reduced mechanical strength of affected bones. This can lead to various complications including deformity, fracture, nerve compression syndromes, and osteoarthritis, although many patients are asymptomatic. Genetic factors play a key role in the pathogenesis of PDB. This seems to be mediated by a combination of rare genetic variants which cause familial forms of the disease and common variants which increase susceptibility to environmental triggers. Environmental factors which have been suggested to predispose to PDB include viral infections, calcium and vitamin D deficiency, and excessive mechanical loading of affected bones. The diagnosis can be made by the characteristic changes seen on radiographs, but isotope bone scans are helpful in defining disease extent. Serum alkaline phosphatase levels can be used as a measure of disease activity. Inhibitors of bone resorption are the mainstay of medical management for PDB and bisphosphonates are regarded as the treatment of choice. Bisphosphonates are highly effective at reducing bone turnover in PDB and have been found to heal osteolytic lesions, and normalize bone histology. Although bisphosphonates can improving bone pain caused by elevated bone turnover, most patients require additional therapy to deal with symptoms associated with disease complications. It is currently unclear whether bisphosphonate therapy is effective at preventing complications of PDB.

scholarly journals Response to zoledronic acid in patients with active Paget's disease of bone: A retrospective study

2019 ◽  
Vol 23 (1) ◽  
pp. 117 ◽  
Author(s):  
Sadishkumar Kamalanathan ◽  
Harsh Durgia ◽  
Jayaprakash Sahoo ◽  
Rajan Palui ◽  
Ritesh Kumar ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Zoledronic Acid ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Paget’S Disease Of Bone ◽  
Paget's Disease Of Bone

Scintigraphic, biochemical, and clinical response to zoledronic acid treatment in patients with Paget’s disease of bone

2008 ◽  
Vol 26 (6) ◽  
pp. 635-641 ◽  
Author(s):  
Avraam Avramidis ◽  
Stergios A. Polyzos ◽  
Efstratios Moralidis ◽  
Georgios Arsos ◽  
Zoe Efstathiadou ◽  
...  
Keyword(s):  
Zoledronic Acid ◽  
Clinical Response ◽  
Acid Treatment ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Paget’S Disease Of Bone ◽  
Paget's Disease Of Bone

scholarly journals Re-treatment of relapsed Paget's disease of bone with zoledronic acid: results from an open-label study

2013 ◽  
Vol 2 ◽  
Author(s):  
Ian R Reid ◽  
Jacques P Brown ◽  
Naomi Levitt ◽  
José A Román Ivorra ◽  
Javier Bachiller-Corral ◽  
...  
Keyword(s):  
Zoledronic Acid ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Paget’S Disease Of Bone ◽  
Paget's Disease Of Bone ◽  
Open Label ◽  
Open Label Study ◽  
Label Study

The effect of zoledronic acid on serum Dickkopf-1, osteoprotegerin and rankl in patients with paget's disease of bone

Bone ◽  
2009 ◽  
Vol 44 ◽  
pp. S289 ◽  
Author(s):  
S.A. Polyzos ◽  
A.D. Anastasilakis ◽  
Z. Efstathiadou ◽  
M. Kita ◽  
I. Litsas ◽  
...  
Keyword(s):  
Zoledronic Acid ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Paget’S Disease Of Bone ◽  
Paget's Disease Of Bone ◽  
Dickkopf 1

Paget’s disease of bone

2013 ◽  
pp. 1237-1244
Author(s):  
Stuart H. Ralston
Keyword(s):  
Bone Turnover ◽  
Viral Infections ◽  
Serum Alkaline Phosphatase ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Paget’S Disease Of Bone ◽  
Bone Architecture ◽  
Paget's Disease Of Bone ◽  
Disease Extent ◽  
Bone Scans

Paget’s disease of bone (PDB) affects up to 1% of people of European origin aged 55 years and above. It is characterized by focal abnormalities of bone remodelling which disrupt normal bone architecture, leading to expansion and reduced mechanical strength of affected bones. This can lead to various complications including deformity, fracture, nerve compression syndromes, and osteoarthritis, although many patients are asymptomatic. Genetic factors play a key role in the pathogenesis of PDB. This seems to be mediated by a combination of rare genetic variants which cause familial forms of the disease and common variants which increase susceptibility to environmental triggers. Environmental factors which have been suggested to predispose to PDB include viral infections, calcium and vitamin D deficiency, and excessive mechanical loading of affected bones. The diagnosis can be made by the characteristic changes seen on radiographs, but isotope bone scans are helpful in defining disease extent. Serum alkaline phosphatase levels can be used as a measure of disease activity. Inhibitors of bone resorption are the mainstay of medical management for PDB and bisphosphonates are regarded as the treatment of choice. Bisphosphonates are highly effective at reducing bone turnover in PDB and have been found to heal osteolytic lesions, and normalize bone histology. Although bisphosphonates can improving bone pain caused by elevated bone turnover, most patients require additional therapy to deal with symptoms associated with disease complications. It is currently unclear whether bisphosphonate therapy is effective at preventing complications of PDB.

Paget’s disease of bone

2016 ◽  
Author(s):  
Stuart H. Ralston
Keyword(s):  
Bone Turnover ◽  
Viral Infections ◽  
Serum Alkaline Phosphatase ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Bisphosphonate Therapy ◽  
Paget’S Disease Of Bone ◽  
Bone Architecture ◽  
Paget's Disease Of Bone ◽  
Disease Extent

Paget’s disease of bone (PDB) affects up to 1% of people of European origin aged 55 years and above. It is characterized by focal abnormalities of bone remodelling which disrupt normal bone architecture, leading to expansion and reduced mechanical strength of affected bones. This can lead to various complications including deformity, fracture, nerve compression syndromes, and osteoarthritis, although many patients are asymptomatic. Genetic factors play a key role in the pathogenesis of PDB. This seems to be mediated by a combination of rare genetic variants which cause familial forms of the disease and common variants which increase susceptibility to environmental triggers. Environmental factors which have been suggested to predispose to PDB include viral infections, calcium and vitamin D deficiency, and excessive mechanical loading of affected bones. The diagnosis can be made by the characteristic changes seen on radiographs, but isotope bone scans are helpful in defining disease extent. Serum alkaline phosphatase levels can be used as a measure of disease activity. Inhibitors of bone resorption are the mainstay of medical management for PDB and bisphosphonates are regarded as the treatment of choice. Bisphosphonates are highly effective at reducing bone turnover in PDB and have been found to heal osteolytic lesions, and normalize bone histology. Although bisphosphonates can improving bone pain caused by elevated bone turnover, most patients require additional therapy to deal with symptoms associated with disease complications. It is currently unclear whether bisphosphonate therapy is effective at preventing complications of PDB.

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