Thirteen cases of advanced
Paget's Disease of bone were treated with
Sodium Etidronate (
EHDP) at 20 mg/kg/day for 6 months and followed at 2 to 3-month intervals for 20 months with serum
alkaline phosphatase, 24-hour urinary
hydroxyproline, radiographic skeletal survey, whole-body scanning with
Tc-99m-Sn-EHDP and F-18, external body counting with the same
radiopharmaceuticals over preselected areas, skin temperature, densitometry of normal phalanges and bone biopsies.
Sodium etidronate had a marked effect on Pagetoid bone in all cases with reduction of bone turnover demonstrated by the chemistries, scanning, external counting, skin temperature and X-ray diffraction studies of the bone biopsies. Normal bone did not appear to be materially affected by the
drug. Complications
drug dose-related included new
pain in 6 cases, two fractures in Pagetoid areas and one case of severe demineralization. There was one case of
spinal cord compression unlikely to be
drug related. All complications cleared or were successfully treated by the end of the study. Some patients continued to show reduction in bone turnover to the end of the study, as long as 14 months after stopping
EHDP. Long-term follow-up is needed for final evaluation of the efficacy of the
drug.
Sodium etidronate shows promise as an agent in the treatment of Paget's Disease. Smaller doses or shorter courses of
therapy or combination of
EHDP and
calcitonin may be just as efficacious and may avoid complications.