This protocol addresses patients with fibrous dysplasia of bone who have concurrent FGF-23-mediated hypophosphatemia and are experiencing persistent moderate-to-severe bone pain that requires bisphosphonate therapy. The metabolic abnormality and the pain together define the management pathway.
Persistent moderate-to-severe bone pain in this setting is the primary clinical driver. Before bisphosphonate therapy can be introduced, the underlying hypophosphatemia must first be corrected — an important sequencing requirement. Hypophosphatemia should be corrected as best as possible prior to initiating bisphosphonates.
Management begins with an initial phase of hypophosphatemia correction using vitamin D analogues and phosphate supplementation — a prerequisite that must be established before any bisphosphonate can be started. The complete protocol, including the specific agents, required duration, monitoring criteria, and subsequent bisphosphonate selection, is detailed in the full structured regimen.