Paget’s disease of bone: normalising bone turnover confers no clinical benefit

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Findings from a new study suggest bisphosphonates should be used to control symptoms rather than to suppress bone turnover.

“Long-term intensive bisphosphonate therapy confers no clinical benefit over symptomatic therapy and is associated with a non-significant increase in the risk of fractures, orthopaedic events, and serious adverse events,” in patients with Paget’s disease of bone (PDB).

So conclude the authors of a new study published in theJournal of Bone and Mineral Research , which investigated the long-term effects of a treatment strategy that aimed to normalise bone turnover in PDB with that of symptomatic relief.

More than 500 patients were enrolled in a three-year extension of the Paget’s Disease: Randomized Trial of Intensive versus Symptomatic Management (PRISM) study with intensive bisphosphonate therapy continued in 270 of these patients. Symptomatic treatment continued in 232 subjects in whom bisphosphonates were only given for bone pain. The study found no clinically important differences in quality of life or bone pain between the groups.

“This is an important study since it shows that clinicians involved in the management of Paget’s disease should be treating the patient and not biochemical markers of bone turnover,” said Dr. Stuart Ralston, senior author of the study. “Bisphosphonates are effective drugs for the treatment of Paget’s but our study suggests that striving to normalise biochemical markers may be harmful.”

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