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PAGET'S BONE DISEASE
Treatment Guideline Chart
Paget's bone disease, also known as osteitis deformans, is characterized by a significant increase in bone resorption and turnover in localized parts of the skeleton causing enlargement and thickening of the bone that is disordered and architecturally unstable.
The prevalence increases with age, with men and women affected equally.
Genetic factors and/or viral infection may play a role in the etiology.
May affect one bone (monostotic) or several bones (polyostotic).
By decreasing frequency, involved bones may include pelvic bone and sacrum, spine, skull and femur, tibia, humeri and clavicles.

Surgical Intervention

  • Eg joint replacement, osteotomy, fracture repair
  • Surgical patients should be pretreated with bisphosphonates to prevent serious bleeding during surgery due to hypervascularity, a symptom of active Paget’s bone disease
    • No clinical trials yet on the recommended timing of such treatment
  • Recommended for:
    • Pagetic fracture repair
    • Knee realignment to decrease mechanical pain, especially in cases where pharmacotherapy is ineffective
    • Hip/knee replacement especially in cases where antiresorptive therapy or osteoarthritis (OA) treatment is ineffective
    • Relief of compression due to pagetic vertebrae on the spinal cord or nerve roots
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