Consensus statement on the modern therapy of Paget's disease of bone from a western osteoporosis alliance symposium

Background: Bisphosphonate therapy remains the most effective way of contro lling Paget's disease of bone (PD). Along with salmon calcitonin, etidronat e has been the mainstay of therapy for similar to 20 years. However, the ad vent of newer bisphosphonates with different molecular actions on osteoclas ts warrants a reevaluation of optimal treatment. Objective: At a symposium of the Western Osteoporosis Alliance, physicians with experience in the management of PD met to review currently available i nformation and generate this consensus statement as a guideline for clinici ans and a source of information for health care payers. Methods: All available randomized, double-blind, controlled studies that co mpared the efficacy of newer bisphosphonates with that of etidronate in the treatment of PD were identified through a search of MEDLINE (R) using the terms Paget's disease, bisphosphonates, pamidronate, etidronate, alendronat e, risedronate, tiludronate, clodronate, calcitonin, and salmon calcitonin. Because no such studies have been conducted for pamidronate, clodronate, o r calcitonin. these drugs were not included in the analysis. Conclusions: The consensus of the symposium was that etidronate has little place in the modern management of PD. Newer bisphosphonates such as alendro nate and risedronate provide significant therapeutic advantages over etidro nate, both in the extent of reduction in bone-specific alkaline phosphatase (BSAP) and/or total serum alkaline phosphatase (SAP) and in the duration o f remission, as measured by normalization of BSAP/SAP. In the absence of a direct comparison between alendronate and risedronate in the treatment of P D, physician choice is likely to be based on personal experience, relative cost, and differences in dosing.