From the Guidelines
Monitoring of Paget's disease (Osteitis Deformans) is not directly addressed in the provided evidence, as the studies focus on breast cancer and Paget's disease of the breast, not Osteitis Deformans.
Methods for Monitoring Paget's Disease of the Breast
- Diagnostic breast imaging: Bilateral diagnostic mammogram with or without ultrasound imaging is recommended as the initial evaluation for patients with breast skin changes suspicious of Paget's disease 1.
- Skin biopsy: Punch biopsy of the skin or nipple biopsy should be performed after imaging findings consistent with overall BI-RADS assessment category 1–3 (negative, benign, or probably benign) 1.
- Breast MRI: Breast MRI is recommended to define the extent of disease and identify additional disease when biopsy of the nipple areola complex is positive for Paget’s disease 1.
- Clinical examination: A complete history and physical examination are necessary for patients with clinical signs suggesting Paget’s disease 1.
- Tissue biopsy: A tissue biopsy should be performed if imaging findings are consistent with an overall BI-RADS assessment category 4 or 5 (suspicious or highly suggestive of malignancy) 1. Note that the question seems to be about Paget's disease (Osteitis Deformans) which is a bone condition, but the provided evidence is about Paget's disease of the breast, a different condition.
From the Research
Methods for Monitoring Paget's Disease
The following methods are used to monitor Paget's disease:
- Plain radiographs of affected bones to assess the extent of the disease 2, 3, 4
- Bone scintigraphy to determine the extent of the disease 2, 3, 4
- Measurement of serum total alkaline phosphatase or more specific markers of bone formation or bone resorption to assess the response to treatment or evolution of the disease in untreated patients 5, 3, 4
- Radionuclide bone scans to determine the response to treatment if markers are normal 3, 4
- CT and MRI scans may be useful in specific cases 5
Biochemical Markers
Biochemical markers used to monitor Paget's disease include:
- Serum total alkaline phosphatase 2, 5, 3, 6, 4
- Intact N-terminal type 1 procollagen propeptide (PINP) 4
- Cross-linked C-telopeptide (CTX) 4
Monitoring Frequency
The frequency of monitoring Paget's disease varies depending on the treatment and disease activity:
- Measurement of total ALP or other baseline disease activity markers at 6 to 12 weeks after treatment 4
- Maximum suppression of high bone turnover may require measurement at 6 months after administration 4
- Biochemical follow-up every 1-2 years after normal bone turnover with zoledronate treatment 4
- Biochemical follow-up every 6 to 12 months with less potent drugs 4