No Benefits for Intensive over Symptomatic Bisphosphonate Treatment in Paget's Disease

Written on 19 February 2017. Posted in Rheumatology News & Perspectives

“Long-term intensive bisphosphonate treatment does not confer any clinical benefit over symptomatic treatment and is associated with a non-significant increase in the risk of fractures, orthopedic events and serious adverse events” in patients with Paget's disease.

This is the conclusion of a new study published in the Journal of Bone and Mineral Research that examined the long-term effects of a intensive treatment with bisphosphonates versus symptomatic relief therapy in patients with Paget's disease. Biphosphonate treatment is believed to normalize bone turnover in Paget’s disease.

More than 500 patients were enrolled in a three-year extension of the Paget's Disease Randomized Trial of Intensive versus Symptomatic Management (PRISM) Study: A Randomized Trial Comparing Intensive Care with Symptomatic Management) in which treatment with bisphosphonates was continued in 270 of these patients, whereas the treatment of first choice was zoledronic acid. Symptomatic treatment was continued in 232 subjects who had received bisphosphonates only for bone pain.

The study revealed no clinically important differences in quality of life or bone pain between groups. In the intensive treatment group there was a non-significant greater risk of fractures, orthopedic events and SAE. Serum ALP levels were significantly higher in the symptomatic treatment group as the difference was greater in the end of the study.

The results of this study suggest that in patients with established Paget's disease, bisphosphonate therapy should focus on control of symptoms rather than suppression of bone turnover.

Tags: drugs, osteoporosis, Paget's disease

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