Drug therapy of Paget's disease (Osteitis Deformans) include all except-
Paget's disease of bone (PDB) is a common condition characterised by focal areas of increased and disorgan ised bone remodelling. It mostly affects the axial skele ton, and bones that are commonly involved include the pelvis, femur, tibia, lumbar spine, skull and scapula. MANAGEMENT-The main indication for treatment with inhibitors of bone resorption is bone pain thought to be due to increased metabolic activity (Box 25.82). It is often difficult Management The main indication for treatment with inhibitors of bone resorption is bone pain thought to be due to increased metabolic activity (Box 25.82). It is often difficult to dif ferentiate this from pain due to complications such as bone deformity, nerve compression symptoms and OA. If there is doubt, it can be wohwhile giving a therapeu tic trial of antiresorptive therapy to determine whether the symptoms improve. A positive response indicates that the pain was due to increased metabolic activity. The aminobisphosphonates pamidronate, zoledronate and risedronate are more effective than simple bisphos phonates such as etidronate and tiludronate at suppress ing bone turnover in PDB, but their effects on pain are similar. Although bisphosphonates suppress bone turn over in PDB, there is no evidence to show that they alter the natural history or prevent complications. Calcitonin can be used as an alternative but is less convenient to administer and more expensive. Repeated courses of bisphosphonates or calcitonin can be given if symptoms recur. If symptoms do not respond to antiresorptive therapy, it is likely that the pain is due to a complication of the disease and this should be managed according to the principles described on page 1085. DAVIDSONS PRINCIPLES AND PRACTICE OF MEDICINE 22ND EDITION PAGE NO-1128,1129
Alendronate
Etidronate
Calcitonin
Plicamycin
Endocrinology