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Paget's Guideline

A clinical Guideline, for the Diagnosis and Management of Paget’s Disease of Bone in Adults, was commissioned by the Paget's Association, with the support of the European Calcified Tissue Society and the International Osteoporosis Society. The Guideline provides evidence-based recommendations for the diagnosis and management of Paget’s disease. It allows health professionals to consider the available evidence and discuss options with the patient. The Association were pleased that the Guideline was in the top 10% of downloaded papers published in the Journal of Bone and Mineral Research 2018 - 2019.

You can download a summary of the Guideline here. Alternatively, download a PDF of the full Guideline here


The following *recommendations were highlighted by the Guideline Development Group as the most important:
1. 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.
2. 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.
3. 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.
4. Treatment aimed at improving symptoms is recommended over a treat‑to-target strategy aimed at normalising total ALP in Paget’s Disease of Bone.
5. 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.

Patient Booklet. The Paget's Association updated its booklet,  'Paget's - The Facts', in line with the Guideline. This is available to download from the members' area of this website and also by contacting the Paget's Association.

In the video below, Professor Mike Stone discusses the Guideline.


Membership of the Paget's Association brings with it many benefits - follow this link for more information about membership.

*Reproduced from 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: A Clinical Guideline. J Bone Miner Res. doi:10.1002/jbmr.3657

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