Medication
Paget Disease Treatment & Management 1 Alendronate. In one study, 6 months of oral alendronate at the recommended 40-mg regimen produced... 2 Pamidronate. Anderson et al induced biochemical remission with one or more complex courses... 3 Risedronate. In a comparative study, normalization of alkaline phosphatase was achieved in 77%...
Procedures
Though few patients with Paget disease ever need surgical treatment, successful surgical management of severe orthopedic complications of this disease has improved the quality of life for these patients.Indications for surgery include unstable fractures and severe arthritis refractory to medical and physical therapy.
Therapy
Paget's disease of the breast 1 Diagnosis. During a mammogram, you stand in front of an X-ray machine designed for mammography. ... 2 Treatment. During a total (simple) mastectomy, the surgeon removes the breast tissue, nipple, areola and skin. ... 3 Preparing for your appointment. ...
Self-care
Lumpectomy to treat Paget's disease of the breast requires follow-up radiation therapy. Lumpectomy wouldn't be recommended if you can't have radiation therapy for some reason. Most women have nipple reconstruction after their treatment.
Nutrition
What is the best treatment for Paget disease?
What are the indications for surgery for Paget disease?
How to diagnose Paget's disease of the breast?
Can lumpectomy cure Paget's disease of the breast?
What is the best treatment for Paget's disease?
Osteoporosis drugs (bisphosphonates) are the most common treatment for Paget's disease of bone. Bisphosphonates are typically given by injection into a vein, but they can also be taken by mouth. When taken orally, bisphosphonates are generally well tolerated but can irritate the stomach.
What is the first-line treatment for Paget disease?
Bisphosphonates are first-line therapy for Paget's disease, and the advent of the new bisphosphonates permits a dramatic improvement in treatment. The optimal treatment regimen should obtain normalisation or quasi-normalisation of markers of bone remodelling.
Is Paget disease asymptomatic?
Paget's disease is usually asymptomatic. The characteristic skeletal lesions or elevated serum alkaline phosphatase levels are often incidentally detected during the evaluation of an unrelated illness. Non-osseous symptoms in Paget's disease are the direct or indirect manifestations of the bone pathology.
Are there any new treatment for Paget's disease?
There is widespread agreement that a single intravenous injection (5 mg) of zoledronate (also known as zoledronic acid) is the first-line therapy for Paget's disease 18, 19.
Who specializes in Paget's disease?
Paget's disease can affect many parts of the body. You may need to see more than one type of doctor, including: Endocrinologists, who treat hormonal and metabolic disorders. Rheumatologists, who treat joint and muscle disorders.
What is Paget's disease What are its symptoms and treatments?
When Paget's disease of bone occurs in an area where nerves pass through the bone, such as the spine and skull, the overgrowth of bone can compress and damage the nerve, causing pain, weakness or tingling in an arm or leg or hearing loss.
What are the three phases of Paget's disease?
The key histopathological feature of Paget disease involveS the bone architecture and includes the three phases of the disease: mixed, osteolytic, and osteosclerotic. These phases may occur at the same time or separately.
How long can you live with Paget disease?
The 5-year survival rate for a patient with Paget disease and sarcoma is 5-7.5%; however, it may be as high as 50% for those who undergo operative tumor ablation and chemotherapy before metastases occur. The 5-year survival rate for elderly patients with primary nonpagetic sarcoma is 37%.
What of the following is the most common appearance of Paget's disease?
Paget's disease can affect any bone in the skeleton. It appears most often in the spine, pelvis, long bones of the limbs, and skull. It can be present in just one bone or in several bones.
What do bisphosphonates do for Pagets disease?
Nitrogen-containing bisphosphonates are among the first line medications being used to treat Paget's disease of bone. They suppress disease activity by reducing osteoclast-mediated bone resorption and bone turnover, which is reflected by the reduction or normalization of the raised serum ALP level.
Can Paget's disease of bone be cured?
There's currently no cure for Paget's disease of bone, but treatment can help relieve the symptoms. If you do not have any symptoms, your doctor may suggest keeping an eye on your condition and delaying treatment until any problems occur.
What does calcitonin do for a person with Paget's disease?
Human calcitonin has proven to be an effective drug in the management of Paget's disease. Bone pain decreased in a high percentage of cases and biochemical indices improved in all but a few instances. Radiologic regression of the disease often was seen after several years of treatment.
How to diagnose Paget's disease?
Tests and procedures used to diagnose Paget's disease of the breast include: Breast exam. Your doctor will check both of your breasts and the lymph nodes in your armpit, feeling for any lumps or other abnormalities. Mammogram.
What type of surgery is needed for Paget's disease?
Surgical options include: Removing the entire breast (mastectomy).
What is the best treatment for Paget disease?
Drug therapy for Paget disease should include bisphosphonate treatment with serial monitoring of bone markers. Response to therapy is indicated by reduction of symptoms and decreases in levels of BSAP (a bone formation marker) and deoxypyridinoline, C -telopeptide, [ 5] or N -telopeptide (bone resorption markers). A sustematic review of 20 studies found moderate-quality evidence that bisphosphonates improved pain in patients with Paget disease. [ 32]
Why is Paget disease treated?
When Paget disease occurs around a joint, treatment is often administered in an attempt to prevent development of osteoarthritis. In addition, young patients with Paget disease and those with high levels of bone-specific alkaline phosphatase (BSAP) are often treated to avoid future complications. The concept that aggressive treatment is associated with prevention of progression and reduction in risk of future complications is not yet supported by clear findings from long-term placebo-controlled trials; however, indirect evidence suggests that this hypothesis is reasonable.
How much zoledronic acid is used in Paget disease?
Response rates were 93.3% at 1 year, 89.5 % at 2 years, and 91.6 % at 3 years. [ 50]
How long does it take for alendronate to normalize?
In one study, 6 months of oral alendronate at the recommended 40-mg regimen produced normalization of alkaline phosphatase in 63% of patients with Paget disease, compared with 17% after treatment with 400 mg/day of etidronate. The mean initial alkaline phosphatase level was 5 times the upper limit of reference range.
What are some orthotic devices for Paget disease?
Orthotic devices, including canes and walkers, may be useful for patients with gait abnormalities resulting from Paget disease that involves the lower limbs. See Rehabilitation for Paget Disease.
How long does it take for alkaline phosphatase levels to increase after Paget disease?
In a long-term follow-up study of 25 patients with active Paget disease who were treated with a single intravenous dose of 6 or 12 mg of ibandronate, Reid et al reported that although some patients showed gradual increases in alkaline phosphatase levels after 20-30 months, levels remained normal 3 years after treatment in 15 of the 25 patients, and after 6 years, six of the patients continued to maintain normal levels without further intervention. [ 36]
What is the short term objective of Paget disease treatment?
The short-term objective of Paget disease treatment is to control disease activity. The long-term objectives of treatment are to minimize or prevent disease progression and to decrease complications from the disease, if possible.
What are the indications for Paget disease?
Indications for treatment — Treatment is indicated in patients with symptomatic Paget disease and in selected asymptomatic patients with significant biochemical abnormalities or imaging changes indicating risk of complications from untreated disease. The goals of treatment are to ease pain and to reduce the rate of bone remodeling towards normal, which will enhance the deposition of normal lamellar bone, decrease the vascularity of bone, and slow disease progression. (See 'Symptomatic Paget disease' below and 'Asymptomatic Paget disease' below.)
What is Paget disease?
Paget disease of bone, also known as osteitis deformans, is a focal disorder of bone metabolism characterized by an accelerated rate of bone remodeling, resulting in overgrowth of bone at selected sites and impaired integrity of affected bone . The main clinical manifestations are pain and deformities in affected areas and a heightened risk of fracture, although many patients are asymptomatic. Osteoarthritis in nearby joints and neurologic disease are common complications, and the vascularity of pagetic bone may result in excessive bleeding during orthopedic surgery on affected areas.
What is the most common symptom of paget disease?
The most common symptom is bone pain at a pagetic site (eg, headache, limb, joint, or back pain) or radicular pain due to neural impingement by pagetic bone.
What is the name of the drug that is used to treat Paget's disease of bone?
Yates AJ, Percival RC, Gray RE, et al. Intravenous clodronate in the treatment and retreatment of Paget's disease of bone. Lancet 1985; 1:1474.
What is the treatment for Paget's disease of bone?
Evans RA, Somers NM, Dunstan CR, et al. Treatment of Paget's disease of bone with a combination of intranasal salmon calcitonin and oral calcium and thiazide. Calcif Tissue Int 1991; 49:164.
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