Management of patients with Paget’s disease: a consensus document of the Belgian Bone Club
Paget’s disease of bone (PDB) is a potentially crippling condition. Pain, fracture, spinal stenosis, nerve entrapment, vascular steal syndrome, secondary osteoarthritis, bone deformity, dental problems, deafness, excessive bleeding during orthopaedic surgery, rare sarcomatous degeneration, and hypercalcaemia constitute complications that may impair the quality of life. The therapeutic approach varies from symptomatic (analgesics, anti-inflammatory drugs) to more specific drugs such as increasingly potent bisphosphonates. Studies such as the PRISM study should in the future help to determine the superiority or not of aggressive treatment over symptomatic treatment in the prevention of complications. Various oral and/or intravenous (I.V.) bisphosphonates have been tested and are currently on the market. The most recently available nitrogen-containing bisphosphonate, I.V. zoledronic acid, is the most potent therapy available for the treatment of PDB. Its therapeutic efficacy, its long-term effect on biologic activity and its good tolerance currently supports its use as a first-line therapeutic option in patients suffering from PDB.
KeywordsBisphosphonates Calcitonin Paget’s disease of bone Therapy
We thank Marie-Christine Hallot for expert technical assistance.
Conflicts of interest
J.P. Devogelaer participated in industry-supported trials on salcatonin (Sandoz, Novartis), etidronate (Procter & Gamble), tiludronate (Sanofi), risedronate (Procter & Gamble) and zoledronic acid (Novartis). Lecture fees or paid advisory board: Lilly, MSD, Novartis, Roche, Servier.
J.M. Kaufman and S. Goemaere declare themselves to have participated in company-sponsored clinical trials involving alendronate (Merck & Co), risedronate (Procter & Gamble), tiludronate (Sanofi-Synthelabo), ibandronic acid (Roche) and zoledronic acid (Novartis), and to have received speaker’s fees and research grants from Procter & Gamble, Sanofi-Aventis, Merck & Co, Roche and GlaxoSmithKline.
Jean-Yves Reginster on behalf of the Department of Public Health Epidemiology and Health Economics of the University of Liège, Liège, Belgium. Date: March 12, 2008. Consulting fees or paid advisory boards: Servier, Novartis, Negma, Lilly, Wyeth, Amgen, GlaxoSmithKline, Roche, Merckle, Nycomed, NPS, Theramex, UCB. Lecture fees when speaking at the invitation of a commercial sponsor: Merck Sharp and Dohme, Lilly, Rottapharm, IBSA, Genevrier, Novartis, Servier, Roche, GlaxoSmithKline, Teijin, Teva, Ebewee Pharma, Zodiac, Analis, Theramex, Nycomed, Novo-Nordisk. Grant Support from Industry: Bristol Myers Squibb, Merck Sharp & Dohme, Rottapharm, Teva, Lilly, Novartis, Roche, GlaxoSmithKline, Amgen, Servier.
P. Bergmann, J.J. Body, Y. Boutsen and S. Rozenberg declare that they have no conflict of interest in the field.
S. Boonen is Senior Clinical Investigator of the Fund for Scientific Research—Flanders, Belgium (F.W.O.—Vlaanderen) and holder of the Leuven University Chair in Metabolic Bone Diseases, supported by Roche & GSK. Dr. Boonen reports having received consulting fees, lecture fees and research support from Novartis, Sanofi-Aventis and Procter & Gamble Pharmaceuticals.
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