open access

Vol 63, No 4 (2012)
Case report
Published online: 2012-08-30
Submitted: 2013-02-15
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Normal bone turnover markers in a patient with active Paget’s disease of bone: response to treatment with zoledronic acid

Stergios A. Polyzos, Athanasios D. Anastasilakis, Panagiotis Anagnostis, Marina Kita, Georgios Arsos, Efstratios Moralidis, Athanasios Papatheodorou, Evangelos Terpos
Endokrynologia Polska 2012;63(4):312-315.

open access

Vol 63, No 4 (2012)
Case report
Published online: 2012-08-30
Submitted: 2013-02-15

Abstract

The treatment of Paget’s disease of bone (PDB) aims at the suppression of abnormal bone turnover; bisphosphonates are currently the treatment of choice. Indications for antiresorptive treatment in symptomatic patients with PDB include bone or joint pain, neurological complications, surgery planned at an active pagetic site and hypercalcaemia from immobilisation. The goals of antiresorptive treatment are clinical improvement and biochemical remission, as assessed by the normalisation of bone turnover markers. Clinical deterioration, especially bone pain, should be considered before deciding to treat patients with late sclerotic (burned-out) PDB. Bone scintigraphy may be of importance in these patients, because it depicts increased osteoblastic activity, when bone markers may not. We present a case of late sclerotic PDB with clinical deterioration but normal bone turnover markers, who experienced significant clinical improvement after treatment with zoledronic acid.

Abstract

The treatment of Paget’s disease of bone (PDB) aims at the suppression of abnormal bone turnover; bisphosphonates are currently the treatment of choice. Indications for antiresorptive treatment in symptomatic patients with PDB include bone or joint pain, neurological complications, surgery planned at an active pagetic site and hypercalcaemia from immobilisation. The goals of antiresorptive treatment are clinical improvement and biochemical remission, as assessed by the normalisation of bone turnover markers. Clinical deterioration, especially bone pain, should be considered before deciding to treat patients with late sclerotic (burned-out) PDB. Bone scintigraphy may be of importance in these patients, because it depicts increased osteoblastic activity, when bone markers may not. We present a case of late sclerotic PDB with clinical deterioration but normal bone turnover markers, who experienced significant clinical improvement after treatment with zoledronic acid.
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Keywords

bisphosphonate; bone scintigraphy; bone-specific alkaline phosphatase; C-terminal telopeptide of type I collagen; Paget’s disease of bone; zoledronic acid

About this article
Title

Normal bone turnover markers in a patient with active Paget’s disease of bone: response to treatment with zoledronic acid

Journal

Endokrynologia Polska

Issue

Vol 63, No 4 (2012)

Pages

312-315

Published online

2012-08-30

Bibliographic record

Endokrynologia Polska 2012;63(4):312-315.

Keywords

bisphosphonate
bone scintigraphy
bone-specific alkaline phosphatase
C-terminal telopeptide of type I collagen
Paget’s disease of bone
zoledronic acid

Authors

Stergios A. Polyzos
Athanasios D. Anastasilakis
Panagiotis Anagnostis
Marina Kita
Georgios Arsos
Efstratios Moralidis
Athanasios Papatheodorou
Evangelos Terpos

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