Paget's disease of bone : the effect of stopping long term human calcitonin and recommendations for future treatment

Evans, Imogen M. A.; Banks, L. M.; Doyle, F. H.; Joplin, G. F.; Pennock, J. M.; Stevenson, JohnC.; Intyre, I.Mac

doi:10.1016/0221-8747(80)90003-x

Cited by 22 publications

(7 citation statements)

References 14 publications

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“…However, such patients require long-term therapy with calcitonin and the therapy is quite expensive [3,4,8,21]. Although the long-term use of calcitonin is safe, it is associated with significant short-term effects [22].…”

Section: Discussionmentioning

confidence: 99%

“…Presently, two main types of drugs (calcitonin and bisphosphonates) are available for the treatment of Paget's disease [3][4][5][6][7][8][9]18]. Over the past few years, various new bisphosphohates have been examined for the treatment of Paget's disease [12][13][14][15]18], for example, etidronate, which has been used over the past 25 years with varying degrees of success [19].…”

Section: Discussionmentioning

confidence: 99%

“…Osteolytic Paget's, on the other hand, appears as areas of radiolucency which in long bones appears as V-shaped, intracortical resorption clefts. The presence of osteolytic lesions in weightbearing long bones are an indication for active treatment to prevent pathological fractures [2,3]. Generally, it may take several years before any signs or symptoms of Paget's disease of bone start to appear, as the disease progress extremely slowly [2--4].…”

mentioning

confidence: 99%

“…disease was the hormone calcitonin [3,4]. Calcitonin has been used successfully over the past two decades to decrease the bone turnover in patients with Paget's disease [5][6][7][8].…”

mentioning

confidence: 99%

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Pamidronate is effective for paget's disease of bone refractory to conventional therapy

Wimalawansa

Gunasekera

1993

Calcif Tissue Int

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Paget's disease of bone is characterized by primary osteoclastic dysfunction and prolonged treatment with conventional medications including calcitonin and etidronate, results in a number of patients becoming refractory to treatment. We have evaluated the effectiveness of three dosage regimes of aminohydroxypropylidene bisphosphonate (pamidronate) in 15 patients with extensive Paget's disease who had become refractory to conventional therapy. Nine patients had pamidronate (intravenous infusion of 30 mg over 4-5 hours at monthly intervals) for 6 months. A further four patients received 30 mg of pamidronate infusion daily for 6 consecutive days and another two patients, 60 mg on 3 consecutive days (total dose of 180 mg/patient). In all three groups the bone-specific alkaline phosphatase and urinary hydroxyproline excretion both fell by 75% (P < 0.001). All but one patient showed a marked improvement in clinical symptomatology (pain and mobility) and biochemical parameters indicating decreased bone turnover. Remissions achieved (> 12 months) with all three regimens were comparable. The pagetic bone pain was reduced and the mobility was significantly improved after 3 months of therapy and was continued for up to 1 year. Currently, it may be difficult to justify the use of intravenous bisphosphonate as the first line of therapy for Paget's disease, but it does seem to have a definite place in patients with severe Paget's disease who do not respond to other therapeutic agents. Here we demonstrate that pamidronate is highly effective in patients with extensive Paget's disease who became refractory to conventional treatment. Further studies are necessary to optimize the dosage and frequency of administration of pamidronate.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…disease was the hormone calcitonin [3,4]. Calcitonin has been used successfully over the past two decades to decrease the bone turnover in patients with Paget's disease [5][6][7][8].…”

mentioning

confidence: 99%

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Pamidronate is effective for paget's disease of bone refractory to conventional therapy

Wimalawansa

Gunasekera

1993

Calcif Tissue Int

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“…In addition, in the present study, total calcium and potassium were monitored in 21 patients after therapy had been discontinued [10].…”

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confidence: 99%

Long-term measurement of skeletal and lean body mass in Paget's disease of bone treated with synthetic human calcitonin

et al. 1982

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Total body calcium (an index of skeletal mass), ulnar bone density, and total body potassium (lean body mass) were followed for up to 5 years in 38 patients with Paget's disease during treatment with synthetic human calcitonin. Calcium was measured by neutron activation, ulnar density by X-ray photodensitometry, and potassium by counting its natural 40K radioactivity. There was a significant rise in total skeletal mass in a group of 8 patients in the 12 months following the start of therapy, but overall, total bone mass and ulnar density remained constant during treatment. Small mean losses of body potassium were observed (approximately 4%) after several years elapsed on treatment. Over an average period of 12 months after discontinuation of therapy in 21 patients there was no significant mean change in calcium or potassium. The means of the ratios of total body calcium divided by predicted normal calcium (over the whole period of measurement) were 1.08 (males) and 0.99 (females) and were not significantly different. Comparison of the ulnar densities of patients and normal subjects gave similar results. The average ratio of measured to predicted normal potassium was 1.13 (both males and females). Thus there was no indication of depletion in skeletal mass below normal either in the untreated disease or resulting from treatment.

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Secondary osteon populations: An algorithm for determining mean bone tissue age

Frost

1987

Am. J. Phys. Anthropol.

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This algorithm explains how bone growth, modeling, and chronological age can affect the mean tissue age of compact bone and suggests how to measure and quantitate those effects. Since a given secondary osteon population density equals the mean annual number of new osteons being created, multiplied by the time over which those creations occur, and that time equals the mean tissue age of the compacta containing the osteons, quantitating age would allow removing its effects on osteon populations in order to study other influences on those populations. These other influences include local and systemic disease, genetics, nutrition, physical activity, occupation, biomechanics, chronological age, sex, and species. In a given bone cross section these influences affect the annual osteon creations rather than the time period over which those creations occur.Interest has developed in trying to understand some of the pathophysiological information inscribed in secondary osteon populations in compact bone (Bouvier and

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Paget's disease of bone : the effect of stopping long term human calcitonin and recommendations for future treatment

Cited by 22 publications

References 14 publications

Pamidronate is effective for paget's disease of bone refractory to conventional therapy

Pamidronate is effective for paget's disease of bone refractory to conventional therapy

Long-term measurement of skeletal and lean body mass in Paget's disease of bone treated with synthetic human calcitonin

Secondary osteon populations: An algorithm for determining mean bone tissue age

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