Paget Disease Guidelines

Updated: Dec 21, 2018
  • Author: Mujahed M Alikhan, MD; Chief Editor: Herbert S Diamond, MD  more...
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Guidelines Summary

A 2014 Endocrine Society Clinical Practice Guideline on Paget disease recommends the following [53] :

  • Plain radiographs of the pertinent regions of the skeleton in patients with suspected Paget disease

  • A radionucleotide bone scan to determine the extent of the disease if the diagnosis is confirmed

  • Measurement of serum total alkaline phosphatase or, when warranted, a more specific marker of bone formation or bone resorption to assess the response to treatment or evolution of the disease in untreated patients

  • Consider treatment with a bisphosphonate for most patients with active Paget disease who are at risk for future complications

  • Consider a single 5-mg dose of intravenous zoledronate as the treatment of choice in patients who have no contraindication

  • Consider measurement of a specific marker of bone formation and bone resorption in patients with monostotic disease who have a normal serum total alkaline phosphatase

  • Consider serial radionuclide bone scans to determine the response to treatment if the markers are normal

  • Bisphosphonate treatment may be effective in preventing or slowing the progress of hearing loss and osteoarthritis in joints adjacent to Paget disease and may reverse paraplegia associated with spinal Paget disease

  • Consider treatment with a bisphosphonate before surgery on pagetic bone