Ralston, S.H., Corral-Gudino, L., Cooper, C. et al. (14 more authors) (2019) Diagnosis and management of Paget's disease of bone in adults: a clinical guideline. Journal of Bone and Mineral Research, 34 (4). pp. 579-604. ISSN 0884-0431
Abstract
An evidence‐based clinical guideline for the diagnosis and management of Paget's disease of bone (PDB) was developed using GRADE methodology, by a Guideline Development Group (GDG) led by the Paget's Association (UK). A systematic review of diagnostic tests and pharmacological and nonpharmacological treatment options was conducted that sought to address several key questions of clinical relevance. Twelve recommendations and five conditional recommendations were made, but there was insufficient evidence to address eight of the questions posed. The following recommendations were identified as the most important: 1) Radionuclide bone scans, in addition to targeted radiographs, are recommended as a means of fully and accurately defining the extent of metabolically active disease in patients with PDB. 2) Serum total alkaline phosphatase (ALP) is recommended as a first‐line biochemical screening test in combination with liver function tests in screening for the presence of metabolically active PDB. 3) Bisphosphonates are recommended for the treatment of bone pain associated with PDB. Zoledronic acid is recommended as the bisphosphonate most likely to give a favorable pain response. 4) Treatment aimed at improving symptoms is recommended over a treat‐to‐target strategy aimed at normalizing total ALP in PDB. 5) Total hip or knee replacements are recommended for patients with PDB who develop osteoarthritis in whom medical treatment is inadequate. There is insufficient information to recommend one type of surgical approach over another. The guideline was endorsed by the European Calcified Tissues Society, the International Osteoporosis Foundation, the American Society of Bone and Mineral Research, the Bone Research Society (UK), and the British Geriatric Society. The GDG noted that there had been a lack of research on patient‐focused clinical outcomes in PDB and identified several areas where further research was needed.
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Copyright, Publisher and Additional Information: | © 2019 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The moral rights of the named author(s) have been asserted. |
Keywords: | ALP; ANTIRESORPTIVES; BISPHOSPHONATES; PAGET'S DISEASE OF BONE; RADIONUCLIDE BONE SCANS; Adult; Alkaline Phosphatase; Biomarkers; Humans; Osteitis Deformans; Practice Guidelines as Topic; Zoledronic Acid |
Dates: |
|
Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine and Population Health |
Funding Information: | Funder Grant number Medical Research Council G0601019 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 25 Nov 2024 11:12 |
Last Modified: | 25 Nov 2024 11:12 |
Published Version: | http://dx.doi.org/10.1002/jbmr.3657 |
Status: | Published |
Publisher: | Oxford University Press (OUP) |
Refereed: | Yes |
Identification Number: | 10.1002/jbmr.3657 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:220029 |
Download
Filename: Diagnosis and Management of Pagets Disease of Bone in Adults A Clinical Guideline.pdf
Licence: CC-BY 4.0