Pharmacotherapy of Paget's disease of bone.

INTRODUCTION: Paget's disease of the bone is a common condition in some populations, affecting almost 10% of older adults in western Europe. Though frequently asymptomatic, it can sometimes result in severe disabilities. Timely intervention is now able to arrest disease progression in the majority of patients. AREAS COVERED: Studies describing the pharmacotherapy of Paget's disease are described in this review, based on a weekly Current Contents search for the term 'Paget' from 1995, and from personal knowledge and published references from earlier literature. EXPERT OPINION: Potent bisphosphonates are the cornerstone of current therapy and have been shown to produce biochemical remission, radiographic healing, pain relief and an improved quality of life. A single intravenous dose of zoledronate has produced the highest response rates and the most sustained remissions of any medication studied so far. It is not clear whether Paget's disease is cured in these patients, or whether they merely undergo a prolonged remission. As a result of this approach, we seldom need to retreat patients and our clinical experience is entirely consonant with the long-term follow-up results from the zoledronate trials, indicating that this treatment results in better clinical outcomes and greater quality of life for patients with Paget's disease.