From the Research
Paget's disease of bone often causes no symptoms initially, but as it progresses, patients may experience bone pain, joint pain, headaches, and hearing loss if the skull is affected, with the most recent and highest quality study suggesting that bisphosphonates, such as zoledronic acid, can effectively manage the disease and improve quality of life 1.
Symptoms of Paget's Disease
The disease can cause bone deformities such as enlarged head, bowed limbs, or curvature of the spine, with patients possibly noticing warmth over affected areas due to increased blood flow. Complications can include:
- Fractures due to weakened bones
- Arthritis in joints adjacent to affected bones
- Rarely, heart failure from increased cardiac output needed to supply the affected bones
- Neurological complications may occur if the disease affects the skull or spine, including nerve compression Some patients experience excessive bone growth that can lead to pinched nerves or spinal stenosis.
Disease Progression and Treatment
The disease results from abnormal bone remodeling where osteoclasts break down bone too quickly and osteoblasts form new bone too rapidly, creating disorganized bone structure that is enlarged but weaker than normal bone, with zoledronic acid being a highly effective treatment option, as shown in a study published in 2020 1.
Management and Quality of Life
Bisphosphonates, such as zoledronic acid, can effectively manage the disease and improve quality of life, with a single intravenous dose of zoledronic acid 5 mg being effective and well tolerated in the treatment of Paget's disease of bone, as demonstrated in a study published in 2007 2.
Treatment Options
Other treatment options, such as alendronate and risedronate, may also be effective, but the most recent and highest quality study suggests that zoledronic acid is the most effective treatment option, with a therapeutic response rate of 96% 1.
Real-World Experience
In a real-world setting, low-dose, once-weekly, oral bisphosphonate preparations can achieve remission in a large proportion of patients with Paget's disease of bone, as shown in a study published in 2019 3.
Comparison of Treatments
A comparison of different intravenous bisphosphonate regimens for Paget's disease of bone found that zoledronate was superior to pamidronate in achieving biochemical remission, with therapeutic response maintained in most patients at 15 months, as demonstrated in a study published in 2007 4.