Which Is The First-Line Treatment For Paget Disease & What Is The Best Treatment For It?

Bisphosphonates are first-line treatment for Paget’s disease, and the initiation of the new bisphosphonates allows remarkable progress in healing.1,2

Paget diseases are treatable. The US FDA has approved several drugs for the treatment of Paget disease.3,4

Oral bisphosphonates are generally well-tolerated and are regarded as the most common treatment for Paget’s disease of bone.5

Paget disease of the bone is a progressive condition that occurs where one or more bones in the body become oversized and weak. This sudden change of condition often results in mishappening and causes a bone breakdown.

Nearly a million individuals have been affected by his condition in the United States. Medical studies demonstrate that Paget disease is most noticed in older adults and primarily those of the European descents.

Which Is The First-Line Treatment For Paget Disease?

Paget disease is a monostotic or polyostotic disorder resulting in bone deformities and a reduced range of motion with pain and often necessitating bone remodeling. This condition occurs in three phases

Initial Phase Or Lytic – This is the early destruction stage of the disease with the occurrence of pathognomonic changes in the bones.

Mixed Lytic And Blastic- It is the intermediate stage of Paget disorder which is followed by the lytic stage. During this phase, the bones begin to enlarge with osteoblastic areas crossing sutures

Sclerotic- In the final phase of the Paget disease, the lower extremity long bones typically demonstrate lateral and anterior deforming.

Paget diseases are treatable. The US FDA has approved several drugs for the treatment of Paget disease. Bisphosphonates are first-line treatment for Paget’s disease, and the initiation of the new bisphosphonates allows remarkable progress in healing.

Nitrogen-containing bisphosphonates such as zoledronic acid, risedronate, and alendronate, suppress disease activity by reducing osteoclast-mediated bone resorption and ease the pain.1,2

What Is The Best Treatment For Paget Disease?

The primary objective of the treatment is to reduce symptoms about pain and to decrease the rate of bone remodeling towards normal. Several treatments aid in the healing of Paget disease

Bisphosphonates – Bisphosphonates are considered to be the treatment of choice to ease pain, slow bone turnover, and improve bone formation. The main goal of bisphosphonate therapy is to focus on the control of symptoms instead of the destruction or deformities of bone.3

Painkillers- Over-the-counter painkillers such as paracetamol and ibuprofen are available for prescription to subside the symptoms produced by Paget disease of the bone. Furthermore, many patients also require treatment with analgesics and anti-inflammatory and non-steroidal anti-inflammatory drugs or with antiresorptive drugs such as calcitonin and bisphosphonates to simply manage this condition.

Surgery- Surgery is generally performed to correct the bone deformity, destruction/damage in the bones. Most cases of Paget disease do not require surgery and can be treated through other therapies and medications. However, surgical management in Paget disease patients has produced successful results thereby improving the quality of life in these patients by a vast extent. Surgery is required in the following cases

  • Severe fractures that need healing
  • Chronic arthritis can damage joints and surgery will be required to replace them
  • In the case of deformed bones, Osteotomy a surgical intervention to straighten the bone.

When there is a compression in the bone, surgery is performed to remove the lamina from the spinal canal thus relieving pressure.4,5

References:

  1. M;, Roux C;Dougados. “Treatment of Patients With Paget’s Disease of Bone.” Drugs, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/10595863/.
  2. “Single Dose IV Medication as First-Choice Treatment for Paget’s Disease, Experts Suggest.” ScienceDaily, ScienceDaily, 19 Nov. 2014, www.sciencedaily.com/releases/2014/11/141119132504.htm.
  3. UpToDate, www.uptodate.com/contents/treatment-of-paget-disease-of-bone.
  4. NHS Choices, NHS, www.nhs.uk/conditions/pagets-disease-bone/treatment/.
  5. Urteaga, Elizabeth M., and Pharmacy Practice University of the Incarnate Word Feik School of Pharmacy. “Treatment of Paget’s Disease of Bone.” U.S. Pharmacist – The Leading Journal in Pharmacy, 19 Oct. 2012, www.uspharmacist.com/article/treatment-of-pagets-disease-of-bone.

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