Rheumatology Department, Addenbrooke's NHS Trust, Hills Road, Cambridge, UK
Correspondence to: A. J. Crisp, Rheumatology Department, Box 204, Addenbrooke's NHS Trust, Hills Road, Cambridge CB2 2QQ, UK. E-mail: ajcrisp{at}addenbrookes.nhs.uk
Sir, In their recent review of the management of Paget's disease, Langston and Ralston perpetuate the advice to administer three infusions of pamidronate 60 mg/day i.v. over 6 weeks [1]. This is profligate of limited day-care resources and of course our patients time.
A single infusion of pamidronate 90 mg achieves normalization of alkaline phosphatase (ALP) in over 70 per cent of patients by 6 months. If ALP remains elevated after 6 months a second dose of 90 mg can be administered to achieve optimal control of disease activity. Long-term efficacy of the Cambridge protocol is indistinguishable from the conventional one with obvious financial and time economies [2, 3].
The author has declared no conflicts of interest.
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