Sagittal reformatted CT showing thickened trabeculae within the vertebral bodies (arrows). Courtesy Dr. H. Dorfman.
bone pain or symptomatic spinal stenosis should be started on anti-pagetic therapy. Several classes of drugs are presently available for the treatment of Paget's disease. The bisphosphonates have been used for quite some time with positive results. These drugs can eliminate symptoms and suppress disease activity for an extended period of time. Alendronate (Fosamax) and Risedronate (Actonel) can be given orally. The former should be administered weekly for a period of three to six months (70 mg/qweek), whereas the latter, the more effective of the two, should be administered daily (30 mg/qd) for a period of two months. Pamidronate, a more potent biphosphonate, can be intravenously administered. Sixty milligrams are mixed in saline and given over a few hours for two to three consecutive days. This drug, which may bring a rather dramatic clinical improvement, is reserved for patients with extensive PD.
Patients who do not tolerate these medications can be started on calcitonin, mithramycin, or gallium nitrate.
In severe symptomatic spinal stenosis that does not respond to medical treatment, and in cases in which cauda equina syndrome develops, surgery should be performed
Altman RD: Musculoskeletal manifestation of Paget's disease of bone. Arthritis Rheum 23: 1121-1127, 1980.
Altman RD: The spine in Paget's disease of bone. Semin Spine Surg 2: 130-135, 1990.
Brown JP, Chines AA, Myers WR, Eusebio RA, Ritter-Hrncirik C, Hayes CW: Improvement of pagetic bone lesions with risedronate treatment: A radiologic study. Bone 26: 263-267, 2000.
Chapman GK: The diagnosis of Paget's disease of bone. Aust N Z J Surg 62: 24-32, 1992.
Chen JR, Richard SCR, Wallach S, Avramides A, Flores A: Neurologic disturbances in Paget's disease of bone: Response to calcitonin. Neurology 29: 448-457, 1979.
Cherian RA, Haddaway MJ, Davie MWJ, MCCall IW, Cassar-Pullicino VN: Effect of Paget's disease of bone on areal lumbar spine bone mineral density measured by DXA, and density of cortical and trabecular bone measured by quantitative CT. Br J Radiol 73: 720-726, 2000.
Gagel RF, Logan C, Melette LE: Treatment of Paget's disease of bone with salmon calcitonin nasal spray J Am Geriatr Soc 30: 1010-1014, 1988.
Hadjipavlou AG, Gaitanis IN, Katonis PG, Lander P: Paget's disease of the spine and its management. Eur Spine J 10: 370-384, 2001.
Hadjipavlou AG, Lander P: Paget's disease of the spine. J Bone Joint Surg Am 73: 1376-1381, 1991.
Jattiot F, Goupille P, Azais I, Roulot B, Alcalay M, Jeannou J, Bontoux D, Valat JP: Fourteen cases of sarcomatous degeneration in Paget's disease. J Rheumatol 26: 150-155, 1999.
Kaufman GA, Sundaram M, McDonald DJ: Magnetic resonance imaging in symptomatic Paget's disease. Skeletal Radiol 20: 413-418, 1991.
Lombardi A: Treatment of Paget's disease of bone with alendronate. Bone 24 (5 suppl.): 59-61, 1999.
Lyles KW, Siris ES, Singer FR, Meunier PJ: A clinical approach to diagnosis and management of Paget's disease of bone. J Bone Miner Res 16: 1379-1387, 2001.
Oostveen JCM, Van de Laar MAFJ: Magnetic resonance imaging in rheumatic disorders of the spine and sacroiliac joints. Semin Arthritis Rheum 30: 52-69, 2000.
Roberts MC, Kressel MD, Zlatkin MB, Dalinka MK: Paget disease: MR imaging findings. Radiology 173: 341-345, 1989.
Rousiere M, Michou L, Cornelis F, Orcel P: Paget's disease of bone. Best Pract Res Clin Rheumatol 17: 1019-1041, 2003.
Saifuddin A, Hassan A: Paget's disease of the spine: Unusual features and complications. Clin Radiol 58: 102-111, 2003.
Schajowicz F, Araujo SE, Berestein M: Sarcoma complicating Paget's disease of bone: A clinico-pathology study of 62 cases. J Bone Joint Surg Br 65: 299-307, 1983.
Tiegs RD, Lohse CM, Wollan PC, Melton LJ: Long-term trends in the incidence of Paget's disease of bone. Bone 27: 423-427, 2000.
Vande Berg BC, Malghem J, Lecouvet FE, Maldague B: Magnetic resonance appearance of uncomplicated Paget's disease of bone. Semin Musculoskelet Radiol 5: 69-77, 2001.
Walsh JP: Paget's disease of bone. Med J Aust 181: 262-265, 2004.
Walsh JP, Ward LC, Stewart GO, Will RK, Criddle RA, Prince RL, Stuckey BG, Dhaliwall SS, Bhagat CI, Retallack RW, Kent GN, Drury PJ, Vasikaran S, Gutteridge DH: A randomized clinical trial comparing oral alendronate and intravenous pamidronate for the treatment of Paget's disease of bone. Bone 34: 747-754, 2004.
Whitehouse RW: Paget's disease of bone. Semin Musculoskelet Radiol 6: 313-322, 2002.
Whitten CR, Saifuddin A: MRI of Paget's disease of bone. Clin Radiol 58: 763-769, 2003.
Zlatkin MB, Lander PH, Hadjipavlou AG, Levine JS: Paget disease of the spine. CT with clinical correlation. Radiology 160: 155-159, 1986.
This page intentionally left blank
Was this article helpful?