When Paget's disease is diagnosed, referral to a specialist for assessment is recommended.
Specific anti-pagetic treatment involves the use of osteoclast inhibitors to reduce the elevation in bone turnover that is characteristic of active disease. In addition, analgesics, non-steroidal anti-inflammatory drugs, and anti-neuropathic pain agents can be used for symptom control.
When treatment is required, Bisphosphonates are used and Zoledronate is often the drug of choice as it acts quickly and can be effective for many years.
The main reason for treatment is if the affected bones are painful. If the pain is directly from Paget’s disease, it often improves with treatment. Pain, however, can arise from complications. The clinical benefit of giving bisphosphonates to patients who have a raised level of alkaline phosphatase in their blood, but do not have symptoms, is unknown. It can take several months for bisphosphonates to have their full effect and for the individual to feel the maximum benefit.
Alkaline Phosphatase (ALP) is an indicator of disease activity and should be measured prior to starting treatment and repeated about 3 months later when it should have decreased. It should be noted that Paget's disease can be active and yet the alkaline phosphatase (ALP) may remain within the normal range, particularly if the area involved is small.