Clinical experience with the use of two diphosphonates in the treatment of Paget's disease.

Dewis, P; Prasad, B K; Anderson, D. C.; Willets, Steve

doi:10.1136/ard.44.1.34

Cited by 26 publications

(5 citation statements)

References 13 publications

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“…Pamidronate was initially utilized in an oral formulation (56)(57)(58)(59), which proved to be poorly tolerated. The drug's availability in the intravenous form for the treatment of malignant bone complications has led to a variety of regimens (60)(61)(62)(63)(64)(65)(66)(67)(68).…”

Section: Pamidronatementioning

confidence: 99%

Paget’s disease

et al. 2014

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Paget’s disease of bone is the most common metabolic bone disease after osteoporosis and affects 2-4% of adults over 55 years of age. Its etiology is only partly understood and includes both genetic and environmental factors. The disease may be asymptomatic and can be uncovered incidentally on x-ray or in biochemical tests performed for another condition. It can also manifest itself with bone pain, deformity, fracture or other complications. Paget’s disease is diagnosed by x-rays and in general has very typical radiological features, but occasionally the clinical picture may be unusual and a differential diagnosis of sclerotic or lytic metastases needs to be considered. Plasma total alkaline phosphatase activity is the most clinically useful indicator of disease activity. It is elevated in most untreated patients, but may be within the normal range in patients with monostotic or limited disease. Bisphosphonate therapy is indicated for patients with symptoms and should also be considered in patients with disease sites that suggest a risk of complications, such as long bones, vertebrae or base of the skull. Orthopedic surgery in Paget’s disease patients includes almost exclusively the correction of fractures and arthroplasty.

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Section: Pamidronatementioning

confidence: 99%

Paget’s disease

et al. 2014

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“…Oral pamidronate 4.5 mg/kg/day has efficacy equivalent to etidronate 20 mg/kg/day [84] and appears to be an optimal oral dose with equivalent efficacy to higher doses, but greater efficacy than an inadequate dose of 50 mg/day. [85] Pamidronate is associated with a high incidence of GI intolerance [86,87] and, in combination with the variable absorption of the bisphosphonates, response to the drug is unpredictable.…”

Section: Pamidronatementioning

confidence: 90%

Bisphosphonates and the Treatment of Bone Disease in the Elderly

1996

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Recognition of the way in which naturally occurring pyrophosphate affects bone metabolism has stimulated the development of a whole series of related compounds, the bisphosphonates. Although the precise mechanism of action of these compounds remains incompletely understood, they have been proven profoundly effective in clinical practice and already constitute a major advance in the therapy of conditions characterised by excessive bone resorption. Serious adverse effects are rare; however, mineralisation problems are a concern, particularly with etidronate. The reduction in bone turnover during prolonged treatment for osteoporosis is also a concern but as yet of uncertain clinical importance. The wide variation in potency of different bisphosphonates in inhibiting the resorption, mineralisation and turnover of bone will increasingly determine which agents are used in various clinical situations. Bisphosphonates are the treatment of choice in Paget's disease and hypercalcaemia of malignancy. They also appear to have potential to alter the course of metastatic bony disease, although the magnitude and clinical importance of any such effect remains unclear. Bisphosphonates show promise in the prevention and treatment of osteoporosis and increase bone mass in postmenopausal and steroid-induced osteoporosis. The effects of these drugs in other situations are less clear and the effects on fracture rates are not yet fully characterised. Optimal regimens have yet to be established but the long half-lives of these agents makes intermittent treatment a rational and convenient approach.

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“…APD may be as effective as calcitonin + EHDP (1‐hydroxyethylidene‐1, 1‐bisphosphonate, another diphosphonate) in severe PDB 12 . However, at high doses EHDP (ie, 20 mg/kg/day) for only three months, may be more effective in severe PDB than lower doses for longer periods 19 . Of course, hospitalization data as provided in the present study are important for accessing total costs of treatment in a population because of the high costs of hospital stay, but full assessment requires data on numbers of PDB patients treated only as outpatients.…”

Section: Discussionmentioning

confidence: 99%

Rates of Paget's Disease of Bone Among Hospital Discharges, by Age and Sex

Polednak¹

1987

J American Geriatrics Society

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Paget's disease of bone (PDB) is of particular public health interest in view of the increasing proportion of elderly persons in Western populations. Data were analyzed on 1,078 hospital discharges with PDB as the principal diagnosis among New York State residents from 1980 to 1983. Rates of PDB per 100,000 total hospitalizations and per 100,000 total population increased with age, and length of hospital stay increased with age in both sexes. These rates were not higher in males than in females except in older age groups. Population rates were similar in blacks and whites except for higher rates among blacks in the greater than or equal to 80 years of age group, and average length of hospital stay was also significantly longer for blacks in this oldest age group. The magnitude of rates suggests a small impact of PDB on morbidity as assessed by hospitalizations.

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Clinical experience with the use of two diphosphonates in the treatment of Paget's disease.

Cited by 26 publications

References 13 publications

Paget’s disease

Paget’s disease

Bisphosphonates and the Treatment of Bone Disease in the Elderly

Rates of Paget's Disease of Bone Among Hospital Discharges, by Age and Sex

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