THE TREATMENT OF PAGET'S DISEASE

by The National Association for the Relief of Paget's Disease

Although it is over 100 years since the disease was first identified there is still no certain cure. Some patients with very mild symptoms and no pain will need little or no treatment beyond mild analgesia. For those with more serve symptoms the last 10-20 years have seen significant advances in treatment which can now effectively treat the condition.

A group of drugs known as bisphosphonates have been developed to Paget's and other bone diseases. Three of these are currently licensed for use in the treatment of Paget's disease and others are in development.

EHDP (Etidronate or Didronel) is a first generation bisphosphonate. It is taken by mouth in tablet form as a single daily dose and is continued for a period of six months. Care has to be taken that the medication is taken on an empty stomach. It can be effective in relieving symptoms but can have stomach pains, nausea and diarrhoea as side effects.

APD Aredia (Pamidronate) is a second generation bisphosphonate and is proving very effective in the management of Paget's disease. It is given usually given in hospital on a day patient basis and is administered directly into the blood stream via a drip and depending on the dose can be repeated over a period of several weeks. The benefits of the treatment can last for several years but it is not possible to predict in advance those patients who will require additional courses of treatment.

Tiludronate (Skelid) represents an important development in the treatment of Paget's disease because, like Didronel it can be given orally but it has a much wider margin of safety because unlike Didronel it does not cause bone demineralisation. Like Didronel it has to be given on an empty stomach and should be taken early in the day so the patient can remain upright immediately after taking the tablet. The initial course of treatment lasts for 12 weeks but can be repeated when necessary.