Diagnosis and management of Paget’s disease of bone in adults: A clinical guideline

Ralston, Stuart H., Corral-Gudino, Luis, Cooper, Cyrus, Francis, Roger M., Fraser, William D., Gennari, Luigi, Guanabens, Nuria, Javaid, M. Kassim, Layfield, Robert, O’Neill, Terence W., Russell, R. Graham G., Stone, Michael D., Simpson, Keith, Wilkinson, Diana, Wills, Ruth, Zillikens, M. Carola and Tuck, Stephen P. (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

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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.

Item Type: Article
Uncontrolled Keywords: alp,antiresorptives,bisphosphonates,paget's disease of bone,radionuclide bone scans,endocrinology, diabetes and metabolism,orthopedics and sports medicine,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2712
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Musculoskeletal Medicine
Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health
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Depositing User: LivePure Connector
Date Deposited: 20 Dec 2018 15:31
Last Modified: 19 Oct 2023 02:19
URI: https://ueaeprints.uea.ac.uk/id/eprint/69403
DOI: 10.1002/jbmr.3657


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