Management of Paget's disease of bone: reply

S. H. Ralston and A. L. Langston1

Institute of Medical Sciences and 1 Health Services Research Unit, University of Aberdeen, Aberdeen, UK

Correspondence to: S. H. Ralston, Institute of Medical Sciences, Foresterhill, Aberdeen AB25 2ZD, UK. E-mail: s.ralston{at}abdn.ac.uk

We thank Drs Jawad and Crisp for their interest in our review [1] and read their comments with interest.

With regard to the terminology for Paget's disease of bone/osteitis deformans/osteodystrophia deformans, we think that ‘Paget's disease of bone’ is as good a name as any, and we use this in preference to others as it is easily understood by health-care professionals and patients alike. We also suggest that when searching Medline for articles, it is useful to use both osteitis deformans and osteodystrophia deformans as search terms. Indeed, we’d recommend also using ‘ostitis deformans’ as it appears that there are many articles that have used this alternative spelling of Sir James Paget's original name for the disease.

We welcome Dr Crisp's comments on the use of pamidronate for the treatment of Paget's disease. The regimen outlined in our paper is that recommended by the manufacturer and outlined in the summary product characteristics for pamidronate as licensed within the UK. We recognize, however, that many other dose regimens of pamidronate have been successfully used in the treatment of Paget's disease and that as far as one can gather, these appear to be equally effective at suppressing serum alkaline phosphatase values [2–6]. There is no evidence to support the view that one regimen of pamidronate is better than another in terms of clinical response (or cost-effectiveness) since they have never been compared with each other in the context of a randomized controlled trial where clinical response and health economic issues have been addressed. This is relevant to the main point that we wanted to get across in our review, which is that there is little evidence to guide clinicians upon what the most appropriate management strategy is for any antiresorptive agent in Paget's disease. This is particularly true with regard to the prevention and treatment of complications of the disease such as fracture, pain, deafness and bone deformity. Hopefully, on-going studies such as the PRISM trial (http://www.abdn.ac.uk/hsru/hta/prism.shtml) will help to answer these questions and contribute to the development of future guidelines that will address the issues of efficient use of NHS time and resources mentioned by Dr Crisp.

S.H.R. acts as a consultant for Proctor & Gamble, Aventis Pharma, and Novartis, which are pharmaceutical companies that manufacture drugs used in the treatment of Paget's disease. S.H.R. and A.L.L. have received funding from the Arthritis Research Campaign, the National Association for the Relief of Paget's disease, Proctor & Gamble Pharmaceuticals and Aventis Pharma for the PRISM trial of treatment strategies in Paget's disease of bone.

References

  1. Langston AL, Ralston SH. Management of Paget's disease of bone. Rheumatology 2004;43:955–9.[Abstract/Free Full Text]
  2. Cantrill JA, Buckler HM, Anderson DC. Low dose intravenous 3-amino-1-hydroxypropylidene-1,1-bisphosphonate (APD) for the treatment of Paget's disease of bone. Ann Rheum Dis 1986;45:1012–8.[Abstract]
  3. Harinck HIJ, Papapoulos SE, Blanksma HJ, Moolenar AJ, Vermeij P, Bijvoet OLM. Paget's disease of bone: early and late responses to three different modes of treatment with aminohydroxypropylidene bisphosphonate (APD). Br Med J 1987;295:1301–5.[ISI][Medline]
  4. Stone MD, Hawthorne AB, Kerr D, Webster G, Hosking DJ. Treatment of Paget's disease with intermittent low-dose infusions of disodium pamidronate (APD). J Bone Miner Res 1992;5:1231–5.[ISI]
  5. Thiebaud D, Jaeger P, Gobelet C, Jacquet AF, Burckhardt P. A single infusion of the bisphosphonate AHPrBP (APD) as treatment of Paget's disease of bone. Am J Med 1988;85:207–12.[ISI][Medline]
  6. Watts RA, Skingle SJ, Bhambhani MM, Crisp AJ. Treatment of Paget's disease of bone with single-dose intravenous pamidronate. Ann Rheum Dis 1993;52:616–8.[Abstract]
Accepted 23 September 2004





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