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
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