What Are Paget's Disease Treatments?
Most people with Paget's disease do not have symptoms. Treatment in such patients would be based on the location of the pagetic bone or if the alkaline phosphatase level is elevated two to four times the normal limits. People with symptoms are treated in various ways.
What Medications Treat Paget's Disease?
The following oral medications may be prescribed by your doctor to control bone or joint pain related to Paget's disease:
Intravenous zoledronic acid is a potent bisphosphonate and is generally very effective in treating symptoms of Paget’s disease. A single dose is given, with possible redosing if symptoms recur. Oral bisphosphonates such as alendronate and risendronate may be used for people who do not want to take an intravenous medication. For people who do not tolerate oral or intravenous bisphosphonates, intranasal calcitonin is a reasonable alternative to inhibit bone loss.
The following are specific instructions for taking oral bisphosphonates and are important to assure proper absorption by the body. Beverages other than plain water (including mineral water), food, and some medications are likely to reduce the absorption of bisphosphonates. Take first thing upon awakening in the morning before other medications and food. Do not take within 30 minutes of consuming food. Take antacids, calcium, vitamin, and mineral supplements, at least two hours after bisphosphonates. Additionally, sit upright or stand for 30 minutes to avoid erosion to your esophagus.
Serum alkaline phosphatase levels are monitored to determine duration of treatment as well as to monitor disease activity and need for retreatment.
Surgery for Paget's Disease
Indications for surgery for Paget's disease include bony deformity, pathologic fractures, and neurologic dysfunction due to spinal stenosis, degenerative joint disease, or malignant transformation to sarcoma.
While many cases of deformity and fractures can be treated non-operatively, some people benefit from surgery to realign the bone and allow for healing in a more natural position.
Patients with neurologic dysfunction due to involvement of the spine may benefit from spinal decompression. This involves removing portions of the bone surrounding the spinal cord and nerve roots to alleviate compression of these structures.
Cases of severe degenerative joint disease, most commonly the hip and knee, may be treated with joint replacement surgery to relieve pain and improve function and mobility.
In the rare cases of malignant transformation to sarcoma, removal of the affected bones may be required.
People with involvement of the joints often benefit from a physical therapy and muscle strengthening program.