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Diagnosis And Management Of Paget's Disease Of Bone In Adults: A Clinical Guideline

S. Ralston, L. Corral-Gudino, C. Cooper, R. Francis, W. Fraser, L. Gennari, N. Guañabens, M. Javaid, R. Layfield, T. O'Neill, R. Russell, M. Stone, K. Simpson, D. Wilkinson, R. Wills, M. Zillikens, S. Tuck
Published 2019 · Medicine

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An evidence‐based clinical guideline for the diagnosis and management of Paget's disease of bone (PDB) was developed using GRADE methodology, by a Guideline Development Group (GDG) led by the Paget's Association (UK). A systematic review of diagnostic tests and pharmacological and nonpharmacological treatment options was conducted that sought to address several key questions of clinical relevance. Twelve recommendations and five conditional recommendations were made, but there was insufficient evidence to address eight of the questions posed. The following recommendations were identified 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 metabolically active disease in patients with PDB. 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 PDB. 3) Bisphosphonates are recommended for the treatment of bone pain associated with PDB. Zoledronic acid is recommended as the bisphosphonate most likely to give a favorable pain response. 4) Treatment aimed at improving symptoms is recommended over a treat‐to‐target strategy aimed at normalizing total ALP in PDB. 5) Total hip or knee replacements are recommended for patients with PDB who develop osteoarthritis in whom medical treatment is inadequate. There is insufficient information to recommend one type of surgical approach over another. The guideline was endorsed by the European Calcified Tissues Society, the International Osteoporosis Foundation, the American Society of Bone and Mineral Research, the Bone Research Society (UK), and the British Geriatric Society. The GDG noted that there had been a lack of research on patient‐focused clinical outcomes in PDB and identified several areas where further research was needed. © 2019 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.
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Increased prevalence of nephrolithiasis and hyperoxaluria in Paget's disease of bone.
D. Rendina (2020)
10.1093/rheumatology/keaa345
Adult Paget disease of bone: a tale of two guidelines.
S. P. Tuck (2020)
10.1007/s00223-020-00758-4
Pattern of SQSTM1 Gene Variants in a Hungarian Cohort of Paget’s Disease of Bone
J. Donáth (2020)
10.1016/j.bone.2020.115465
Bisphosphonates in the management of Paget's disease.
S. Ralston (2020)
10.4103/ijem.ijem_480_20
Paget’s Disease of Bone Revisited: The Changing Indian Scenario
K. Cherian (2020)
10.1002/msc.1497
Guidelines for the use of diagnostic imaging in musculoskeletal pain conditions affecting the lower back, knee and shoulder: A scoping review.
Andrew Cuff (2020)
10.3399/bjgp20X713369
Paget’s disease of bone: when and why to refer to specialist care
Catherine Nairn (2020)
10.11005/jbm.2020.27.1.71
Paget's Disease of Bone Affecting Peripheral Limb: Difficulties in Diagnosis: A Case Report
Jun-Ku Lee (2020)
10.1007/s00393-020-00897-x
[Paget's disease of bone-a current review of clinical aspects, diagnostics and treatment].
P. Klemm (2020)
10.2169/internalmedicine.4886-20
Incidentally Discovered Paget's Disease of Bone
K. Takahashi (2020)
10.1210/clinem/dgaa252
Mutation of PFN1 gene in an early onset, polyostotic Paget's-like disease.
D. Merlotti (2020)
10.1097/RLU.0000000000003360
"Skull on Fire": Monostotic Paget Disease of the Skull Bone.
Stefan Govers (2020)
10.1007/s11154-020-09544-x
Clinical features, diagnosis and treatment of Paget’s disease of bone in mainland China: A systematic review
Qinyi Wang (2020)
10.1159/000507663
Quantitative Bone Single Photon Emission Computed Tomography/Computed Tomography for Evaluating Response to Bisphosphonate Treatment in Patients with Paget's Disease of Bone
K. Kitajima (2020)
10.1002/jbmr.3964
The Loss of Profilin 1 Causes Early Onset Paget's Disease of Bone
F. Scotto di Carlo (2020)
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