Diagnosis and current management of Paget's disease of bone

Abstract

• Paget's disease affects about 5% of the overall population with a slight male predominance. Between 12 and 40% of patients with Paget's disease of bone have at least one affected first degree relative. • Measurement of total serum alkaline phosphatase is a simple and sensitive screening test that can also be used to monitor therapy. Screening should be considered in family members with unexplained musculoskeletal symptoms. • In asymptomatic individuals, Paget's disease may be diagnosed either as a result of an elevated alkaline phosphatase finding or as an incidental finding on radiographs. • Bisphosphonate therapy is now regarded as the treatment of choice for symptomatic patients. Potent oral agents taken for three to six months produce long term suppression of disease activity. • Symptomatic disease and preparation for orthopaedic surgery are major indications for bisphosphonate therapy, with potent oral agents offering the potential to modify the course of the disease. • Asymptomatic individuals who have involvement at sites that may be prone to complications should be referred for an opinion regarding use of antiresorptive therapy.