Paget's%20bone%20disease Management
Follow Up
Frequency and extent of follow-up will depend upon severity of disease
- Monitor serum alkaline phosphatase (ALP) every 3-6 months to determine the biochemical response to bisphosphonate therapy
- Once the value of serum ALP plateaus after 3-6 months of assessment, it can be measured 1-2x/year as a marker of bone activity
- A more specific bone formation/resorption marker other than ALP (ie amino-terminal propeptide of type 1 collagen [P1NP], βC-terminal propeptide of type-1 collagen [βCTx], N-terminal propeptide of type 1 collagen [NTx] assay) may be measured for patients with untreated monostotic Paget’s disease
- Serial imaging tests (eg bone scan) are not generally useful in routine monitoring of treatment response
- Bone scan may be helpful in monitoring treatment response after 6-12 months of treatment in patients with monostotic disease
- If treatment failure is apparent consider re-treatment 6 months after the initial therapy for the following:
- Symptom relapse or persistence
- >25% above nadir of serum ALP in asymptomatic patient
- Long-term evolution increases the risk for osteosarcoma on pagetic bone