Abstract
Purpose: Paget disease is a disease of bone of unknown etiology with increased bone turnover that results in defective bone microarchitecture and bone deformity. Bisphosphonates are used in symptomatic Paget disease of bone. Clinical trials have shown that zoledronic acid was more effective than other bisphosphonates in treatment of Paget disease. Methods: In this study, we retrospectively reviewed the remission and relapse statuses of 12 patients with Paget disease of bone, who were seen as outpatients between October 2011 and October 2013. We evaluated alkaline phosphates, osteocalcin, deoxypyridinoline levels measured before and at 6th, 12th, 18th months of treatment. Results: Pretreatment values for alkaline phosphates, deoxypyridinoline, osteocalcin were as follows; 473 ± 256 U/L, 14.99 ± 7.63 mmol/L, 21.09 ± 3.18 ng/ml and post-treatmen valus for alkaline phosphates, deoxypyridinoline, osteocalcin were as follows; 82 ± 13 U/L, 5.14 ± 1.11 mmol/L, 8.57 ± 4.31 ng/ml. Remission was achieved in all patients after treatment. The levels indicated remission continued at 12th and 18th months of treatment. There was statistically significant difference between pretreatment and post-treatment values. No statistically significant difference between the levels measured at 6th, 12th and 18th months of treatment was detected. Conclusion: We recommend zoledronic acid in the first line treatment of Paget disease of bone in achieving and maintaining remission.
Highlights
Paget disease is a disorder of bone of unknown etiology with increased bone turnover that results in defective bone microarchitecture
Alkaline Phosphates (ALP), Osteocalcin (OC), and Deoxypyridinoline (DPD) levels measured before and at 6th, 12th, 18th months of treatment were retrospectively reviewed in twelve patients diagnosed with Paget disease treated with zoledronic acid between October 2011 and October 2013
Patients whose ALP levels reduced by 75% of the basal levels or within normal range according to the reference values were regarded as remission and 20% increase in the basal levels was regarded as relapse
Summary
Paget disease is a disorder of bone of unknown etiology with increased bone turnover that results in defective bone microarchitecture. Defective microarchitecture results in deformity in skull and long bones, arthritis, deafness and pathologic fractures. Quality of life in patients with Paget disease is worse than normal population [1]. While formerly calcitonin was used in treatment of symptomatic Paget disease, bisphosphonates are used currently for the same indication. A significant improvement in quality of life was reported with zoledronic acid treatment [2]. Normalization in bone turnover, restoration in structure of bone, and regression in bone lesions were observed with bisphosphonate treatment [3]. Quite low recurrence rates were reported in patients with Paget disease treated with zoledronic acid [6]
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