Introduction: Bisphosponates have long been used with success in the treatment of Pagets disease of bone (PDB). The aim of this study was to evaluate the early (up to three months) and late (at twelve months) scintigraphic, biochemical and clinical response to a single intravenous infusion of zoledronic acid (ZOL) in patients with PDB serially assessed for one year.
Materials and methods: Nine patients with 30 bone lesions due to PDB were prospectively evaluated. Total serum alkaline phosphatase (SAP) was serially measured. Scintigraphy was performed before, three and twelve months after ZOL administration and bone lesions were assessed quantitatively.
Results: After treatment, pain was alleviated in five out of six patients starting from the first month. At three months, a significant decrease of SAP levels compared to baseline values was found (322±211 IU/l before versus 101±36 IU/l three months after, P<0.05), with normal values attained in all but one patient. The scintigraphic index of involvement (SII), a marker for the per-patient activity of the disease, was reduced from 14.4±7.6 to 7.2±1.8 (P=0.01). The scintigraphic ratio (SR), a marker for the per-lesion activity of the disease, was reduced from 12.8±7.7 to 7.0±2.9 (P<0.001). The values of markers of disease activity remained unchanged up to twelve months.
Conclusion: A single intravenous administration of ZOL leads to a favorable clinical, biochemical and scintigraphic response in patients with PDB starting as early as three months after treatment and lasting no <12 months (i.e considerably longer than the existing other therapies).
03 - 07 May 2008
European Society of Endocrinology