Paget's disease of bone - Treatment

Treatment aims to control disease activity and reducing or preventing the progression of pathogenic complications.Indications for treatment include complications of Paget's disease: skeletal deformities, bone pain, congestive heart failure, hypercalcemia, spinal cord compression and nerve radacinolor, eight cranial nerve compression or bone of the optic nerve, the formation of kidney stones by hypercalcemia or recurrent fractures.When Paget's disease occurs around a joint treatment is administered in an attempt to prevent the development of osteoarthritis. Also younger patients with Paget's disease are treated to prevent future complications.
Medical therapy.Medical therapy includes administration of bisphosphonates and bone markers for monitoring series. Due to increased risk of malignancy, Paget's disease patients should be monitored indefinitely. Steroidal anti-inflammatory drugs and acetaminophen are effective pain control. Orthopedic devices, and the walking sticks are useful in patients with Paget's disease affecting the lower limbs and have weight problems. Chemotherapy, radiotherapy or both are used to treat Paget's bone neoplasms occurring.
Calcitonin inhibits osteoclast activity and decreases rapidly resorbed bone. Calcitonin is available from various sources: swine, synthetic, in print, salmon and human. Used regimen is intramuscular injection daily for one month followed by three injections per week for several months and the total duration of treatment depends on severity. Pain reduction occurs in two weeks and is sustained for several months. In 30-60% of patients treated with salmon calcitonin or porcine antibodies appear, and they become resistant to treatment. Secondary hyperparathyroidism occurs in other patients.
Plicamicina and gallium nitrate. Plicamicina formerly called mitramicina is an antibiotic that inhibits RNA synthesis. Intravenous administration for 10 days reduces the pain and bone turnover. It is associated with dose-limiting toxicity to bone marrow, liver and kidneys and is not approved for treatment in any country. Gallium nitrate inhibits bone resorption by inhibiting osteoclast pump is not approved yet.
Bisphosphonates bind to bone mineral structure (phosphorus-calcium-phosphorus) and inhibit the formation and dissolution of calcium phosphate crystals. They decrease osteoclast activity and bone resorption, reduced number of osteoclasts and osteoblasts stimulates secretion. The new bone formed during treatment is lamellar-normal. Etridonatul is available for treatment. Unlike calcitonin disease activity remains low for many months and even years after treatment with bisphosphonates. They relieve deafness, spinal cord compression, reduce bone pain. Other bisphosphonates are using pamidronate, alendronate, clodronate, tiludronic.
Surgical therapy.The indications for surgical treatment of Paget's disease include bone deformities, pathological fractures, nerve compression and degenerative arthritis of the knee and thigh. Total Reinlocuirea thigh or tibia osteotomy are effective for relieving pain and restoring mobility. Pharmacologic therapy with bisphosphonates can be used before surgery to reduce disease activity and prevent blood loss during surgery.After surgery, bone healing can be prolonged and require rehabilitation. Amputation may also be necessary in the presence of malignant transformation. Laminectomiile decompression may be necessary if medical therapy can induce recovery of neurological sequelae in patients with spinal cord compression.
Prognosis.Paget disease morbidity may be extensive and result in bone pain, osteoarthritis and fractures. Increasing mortality associated with Paget's disease is due to disease complications, especially those associated with fracture and sarcoma. Most patients with Paget's disease who develop sarcoma die within three years after diagnosis. Cause excessive bleeding after Hipervascularizarea bone fractures or surgery and is associated with potentially severe consequences.
Treatment of Paget's disease has undergone many changes over the past 25 years due to development of specific inhibitors of osteoclasts, and more recently of potent bisphosphonates. In patients treated successfully with calcitonin and bisphosphonates new lamellar bone is formed under treatment, and radiological evidence, clinical and biochemical patient had improved. The new bisphosphonates therapy is now controllable disease activity.