Recommendations for Clinicians

A clinical Guideline, for the Diagnosis and Management of Paget’s Disease of Bone in Adults, was commissioned by the Paget's Association and published in 2019, in the Journal of Bone and Mineral Research. It has been endorsed by the European Calcified Tissues Society, the International Osteoporosis Foundation, the American Society of Bone and Mineral Research, the Bone Research Society (UK), and the British Geriatric Society. 

These are the recommendations* highlighted by the Guideline Development Group as the most important:

  • Radionuclide bone scans, in addition to targeted radiographs, are recommended as a means of fully and accurately defining the extent of the metabolically active disease in patients with Paget’s Disease of Bone.
  • Serum total alkaline phosphatase (ALP) is recommended as a first-line biochemical screening test, in combination with liver function tests, in screening for the presence of metabolically active Paget’s Disease of Bone.
  • Bisphosphonates are recommended for the treatment of bone pain associated with Paget’s disease. Zoledronic acid is recommended as the bisphosphonate most likely to give a favourable pain response.
  • Treatment aimed at improving symptoms is recommended over a treat‑to target strategy aimed at normalising total ALP in Paget’s Disease of Bone.
  • Total hip or knee replacements are recommended for patients with Paget’s Disease of Bone who develop osteoarthritis, for whom medical treatment is inadequate. There is insufficient information to recommend one type of surgical
  • approach over another.

You can download a summary of the Guideline here.

*Reproduced from the following paper: Ralston, S. H., Corral-Gudino, L., Cooper, C., Francis, R. M., Fraser, W. D., Gennari, L., Guañabens, N., Javaid, M. K., Layfield, R., O’Neill, T. W., Russell, R. G., Stone, M. D., Simpson,
K., Wilkinson, D., Wills, R., Zillikens, M. C. and Tuck, S. P. (2019), Diagnosis and Management of Paget’s Disease of Bone in Adults: Journal of Bone Mineral Research. Vol. 34, p 579-604.

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