Treatment of Paget's Disease of Bone with Fracture in Pagetic Bone
Fractures occurring within bones affected by Paget's disease represent a distinct clinical situation. The abnormal bone remodelling characteristic of this condition alters structural integrity, complicating both fracture healing and disease management.
Clinical Scenario
This protocol addresses patients with confirmed Paget's disease of bone who sustain a fracture in a pagetic bone. Managing such fractures requires an integrated approach that addresses the mechanical failure of the bone alongside the active metabolic bone disease.
Treatment Approach
Management involves surgical stabilization of the fracture combined with bisphosphonate therapy to control the underlying disease activity. The full regimen — including specific agents and their parameters — is available in the complete structured protocol.
Complete agent selection, route, and duration are detailed in the full protocol.
Treatment Goals
- Normalization of serum total alkaline phosphatase at 3–6 months after treatment
- Resolution of bone pain
- Improvement of osteolytic bone lesions on plain radiograph at 12 months
References
- ORIF is recommended in treating fractures of pagetic bone.
- Treatment response is best assessed by measuring serum total ALP 3–6 months after treatment and then annually once levels are normalised.
- If there are osteolytic lesions, the plain film should be repeated at 12 months to assess for improvement.
- They are the only agents that have been evaluated in randomised clinical trials to significantly reduce bone pain, accelerate the healing of lytic lesions, reduce bone turnover markers and improve quality of life when compared with placebo.
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