Treatment of Paget’s Disease of Bone with Denosumab: Case Report and Literature Review

Reid, Ian R.; Sharma, Suresh D.; Kalluru, Ramanamma; Eagleton, Carl

doi:10.1007/s00223-016-0150-6

Cited by 48 publications

(34 citation statements)

References 16 publications

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“…There have been two case reports in the use of denosumab 60 mg by subcutaneous injection every 6 months in PDB in patients where bisphosphonates were poorly tolerated or contraindicated. In both cases, denosumab resulted in a decrease in total ALP concentrations and an improvement of bone pain . Three open‐label trials have been conducted to study the effects of denosumab in the treatment of GCT, but PDB was an exclusion in two of these studies and in the third, no information on co‐existing PDB was available .…”

Section: Results and Recommendationsmentioning

confidence: 99%

Diagnosis and Management of Paget's Disease of Bone in Adults: A Clinical Guideline

Ralston

Corral‐Gudino

Cooper

et al. 2019

Journal of Bone and Mineral Research

140

169

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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, pharmacological and non-pharmacological treatment options was conducted which 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. Radionuclide bone scans, in addition to targeted radiographs, are recommended as a means of fully and accurately defining the extent of the metabolically active disease in patients with PDB.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.Bisphosphonates are recommended for the treatment of bone pain associated with Paget’s disease. Zoledronic acid is recommended as the bisphosphonate most likely to give a favourable pain response.Treatment aimed at improving symptoms is recommended over a treat-to-target strategy aimed at normalising total ALP in PDB.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.

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Section: Results and Recommendationsmentioning

confidence: 99%

Diagnosis and Management of Paget's Disease of Bone in Adults: A Clinical Guideline

Ralston

Corral‐Gudino

Cooper

et al. 2019

Journal of Bone and Mineral Research

140

169

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“…[9101112131415] Use of denosumab in Paget's disease was not established yet. [16] Since risk of medication-related osteonecrosis of the jaw (MRONJ) was reported in the patients who were treated with denosumab for 10 years. It is not a good choice either.…”

Section: Discussionmentioning

confidence: 99%

Paget's Disease: Skeletal Manifestations and Effect of Bisphosphonates

2017

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BackgroundPaget's disease of bone leads to change in the shape and size of the bone and results in reduced bone strength, leading to the complications of deformity, arthritis, and fracture. Due to unknown reasons, Paget's disease is rare in Asian descendants. We report the cases of Paget's disease who visited our institute for 15 years and reviewed the literatures.MethodsWe retrospectively reviewed the medical records and radiograms of 8 patients (6 female and 2 male) who were diagnosed as Paget's disease of bone. Diagnosis was confirmed by typical radiological feature in the involved skeletons and/or pathologic findings.ResultsPelvis, skull and spine were three most frequently involved bones. All involved bones in our cases showed changes in shape and trabecular pattern which resulted in bowing of lower extremity, secondary osteoarthritis, compression fracture of spine and enlargement of skull. Mean follow time was 4.71 years and all patient were treated bisphosphonate (BP). Use of BP controlled the level of serum alkaline phosphatase level effectively.ConclusionsWe have reviewed eight patients who were previously diagnosed as Paget's disease of bone in our institute. We could identify typical radiologic and clinical findings such as bowing deformity of long bone, secondary osteoarthritis, compression fracture and osteomyelitis of mandible that deteriorated the quality of their living.

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“…Nowadays, calcitonin is only considered as an alternative therapy in patients who cannot tolerate bisphosphonates and is used mainly in patients with eGFR less than 30 ml/ min. Cases of patients treated effectively with denosumab showing a short-term decline in headache severity have also been reported 37 . Patients with skull involvement tend to show less biochemical response to treatment 22 .…”

Section: Treatment Optionsmentioning

confidence: 99%