Description

In symptomatic patients Paget’s disease is usually an obvious diagnosis and biochemistry, radiography and scintigraphy will establish disease activity and extent. A high percentage of patients with Paget’s however, are asymptomatic and remain undiagnosed. There is an apparent decrease in disease prevalence in the UK and debate persists about the aetiology of Paget’s with increasing evidence for the importance of genetic factors. Since the majority of patients who present to physicians have symptoms their management should aim to relieve symptoms and prevent development of complications. Bisphosphonates are drugs of first choice, suppressing disease activity with a long duration of effect. Oral tiludronate or risedronate and intravenous pamidronate offer advantages in different circumstances and therapy can be tailored to suit individual requirements. Following an initial preference for oral therapy, concordance and polypharmacy may dictate that IV treatment is preferable. If side effects occur a switch between modalities may prolong therapeutic benefit. Neurological complications can respond to bisphosphonates and/or calcitonin but may
also require surgical decompression. Surgical intervention should be considered in patients with severe deformity, degenerative disease, complete and painful fissure fractures. Treatment of asymptomatic Paget’s may be prudent in patients with active disease involving bones that commonly develop serious complications.