Paget Disease of Bone : Treatment
Image Description
Paget Disease of Bone (PDB) - Treatment: When PDB involves a single bone, it is usually of little clinical consequence other than some pain and bone deformity. However, in patients with more extensive disease, several issues need to be addressed which require a team approach.
Analgesics: Pain from PDB itself as well as from complications such as secondary osteoarthritis responds to analgesics like Tylenol or ibuprofen and other NSAIDs.
Pharmacological Treatment - BISPHOSPHONATES: The pharmacological treatment of PDB aims at reducing osteoclast function with bisphosphonates (BPs). This drug enters the osteoclasts and shuts down key enzymatic processes and promotes osteoclast apoptosis (see detailed discussion in the next image). DENOSUMAB: This is a human monoclonal antibody that binds to RANKL and shuts down RANK-NF-κB signaling pathway, thereby inhibiting osteoclast formation, maturation, and survival (see additional details with image 27).
Calcitonin: Calcitonin reduces bone turnover and promotes healing of lytic lesions. However, it is rarely used these days due to the availability of better alternatives. It requires daily subcutaneous injections and shows rapid disease relapse after cessation of treatment.
Orthopedic Surgery & Supportive Care: In addition, patients may require orthopedic surgery for correction of deformity, joint replacement, treatment of fracture, and nerve compression. The patients can be further helped by physiotherapy, occupational therapy and orthotics.
Illustration created with: BioRender.com
Analgesics: Pain from PDB itself as well as from complications such as secondary osteoarthritis responds to analgesics like Tylenol or ibuprofen and other NSAIDs.
Pharmacological Treatment - BISPHOSPHONATES: The pharmacological treatment of PDB aims at reducing osteoclast function with bisphosphonates (BPs). This drug enters the osteoclasts and shuts down key enzymatic processes and promotes osteoclast apoptosis (see detailed discussion in the next image). DENOSUMAB: This is a human monoclonal antibody that binds to RANKL and shuts down RANK-NF-κB signaling pathway, thereby inhibiting osteoclast formation, maturation, and survival (see additional details with image 27).
Calcitonin: Calcitonin reduces bone turnover and promotes healing of lytic lesions. However, it is rarely used these days due to the availability of better alternatives. It requires daily subcutaneous injections and shows rapid disease relapse after cessation of treatment.
Orthopedic Surgery & Supportive Care: In addition, patients may require orthopedic surgery for correction of deformity, joint replacement, treatment of fracture, and nerve compression. The patients can be further helped by physiotherapy, occupational therapy and orthotics.
Illustration created with: BioRender.com