From the Research
Monitoring Protocols for Paget's Disease of the Bone
The monitoring protocols for Paget's disease of the bone involve a combination of radiological investigations and biochemical evaluations.
- Plain radiographs are recommended for patients with suspected Paget's disease to confirm the diagnosis 1, 2.
- A radionuclide bone scan may be used to assess the extent of the disease 3, 1.
- Measurement of serum total alkaline phosphatase or more specific markers of bone formation or bone resorption is recommended to assess the response to treatment or evolution of the disease in untreated patients 1, 2.
- Serial radionuclide bone scans may be used to determine the response to treatment if the markers are normal 1.
- Biochemical follow-up is recommended to be used as a more objective indicator of relapse rather than symptoms, with measurement of total ALP or other baseline disease activity markers at 6 to 12 weeks and 6 months after administration 2.
- The prolonged response after zoledronic acid treatment should be assessed every 1-2 years after normal bone turnover, while less potent drugs require assessment every 6 to 12 months 2.
Radiological Investigations
Radiological investigations play a crucial role in the diagnosis and monitoring of Paget's disease of the bone.
- Isotope bone scans and radiographs are the most frequent radiological investigations, demonstrating the extent of the disease and characteristic appearances in most cases 4.
- Computed tomography (CT) and magnetic resonance (MR) imaging may be used for the evaluation of less typical disease or disease complications 4.
- Dual energy X ray absorptiometry or quantitative CT may be used to assess bone mineral density, with careful assessment of the images acquired to avoid underestimation of fracture risk 4.
Biochemical Evaluations
Biochemical evaluations are essential for monitoring the response to treatment and the evolution of the disease in untreated patients.
- Serum total alkaline phosphatase is a commonly used marker of bone formation, while more specific markers such as PINP (intact N-terminal type 1 procollagen propeptide) or CTX (cross-linked C-telopeptide) may also be used 1, 2.
- Measurement of these markers at baseline and after treatment can help assess the response to treatment and the risk of future complications 1, 2.