From the Research
Paget's disease of bone can be painful, and the pain is typically characterized as deep, aching, and persistent, resulting from increased bone turnover and abnormal bone remodeling. This condition often affects the pelvis, spine, skull, and long bones of the legs, and pain may worsen with weight-bearing activities or at night 1, 2. The pain is a significant aspect of the disease, as it can lead to bone deformities, fractures, and pressure on surrounding nerves and tissues, ultimately affecting the patient's quality of life.
Causes and Complications
The increased bone remodeling in Paget's disease can lead to various complications, including bowing deformity of the long bones, fracture, and nerve compression syndromes 3, 4. Additionally, the disease may cause hearing loss, other neurological complications, heart failure, and, rarely, osteosarcoma 4. The therapeutic approach varies from symptomatic treatment with analgesics and anti-inflammatory drugs to more specific treatments like bisphosphonates 2.
Treatment Options
For those experiencing pain, treatment options include non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for mild pain [@Example@]. For more severe pain, bisphosphonates such as zoledronic acid (5mg IV once yearly) or alendronate (40mg daily for 6 months) are often prescribed to reduce bone turnover and alleviate pain 1, 2. These medications work by inhibiting the excessive bone resorption characteristic of Paget's disease, thereby reducing inflammation and stabilizing bone structure.
Comprehensive Treatment Approach
Pain management should be part of a comprehensive treatment approach that includes regular monitoring of bone health and addressing any complications that may develop [@Example@]. The most recently available nitrogen-containing bisphosphonate, i.v. zoledronic acid, is the most potent therapy available for the treatment of Paget's disease, and its therapeutic efficacy, long-term effect on biologic activity, and good tolerance support its use as a first-line therapeutic option in patients suffering from Paget's disease 2.
Key Considerations
It is essential to note that the management of patients with Paget's disease should be based on clinical observation and theoretical considerations, as there is no consensus on the threshold values for retreatment, and few studies have evaluated the long-term effects of inhibitors of osteoclastic resorption on the risk of complications 5, 3. However, the progressive nature of the disease, the severity of its complications, and its potential negative impact on quality of life have led many experts to recommend treatment of asymptomatic patients who have active disease at sites where complications are likely to develop 3.