The authors treated 18 patients with
Paget's disease of bone (12 men and 6 women, age 65 +/- 5 years) with
pamidronate (
bisphosphonate of the second generation). Three patients from this group were treated previously without success with
calcitonin or
bisphosphonate of the first generation (
etidronate) 50% of the patients suffered from the polyostotic form of the disease. In one patient a rare combination of
primary hyperparathyroidism with Paget's
bone disease was found and in another patient later an
osteosarcoma developed in the affected bone. To all patients
sodium pamidronate was administered (
Aredia, Ciba-Geigy) 30 mg per day by i.v. infusion for 2 hours during three days. Four patients developed
fever, two patients
phlebitis at the site of injection. These side-effects are described by the manufacturer. Two patients developed transient regional
alopecia, not described so far. Subjective
pain relief of the affected skeleton occurred in one patient after one month of treatment, after three months in 78%. Laboratory manifestations of activity of the disease (serum activity of
alkaline phosphatase,
tartrate resistant acid phosphatase and hydroxyprolinuria) declined gradually from the 1st to the 6th month after onset of treatment. There was a less marked decline of the
osteocalcin serum concentration. The concentration of
calcium,
phosphorus and
vitamin D metabolites did not change markedly. Twelve months
after treatment 14.7% of the patients were inactive according to laboratory tests, 73% however experienced another rise of parameters of osteoresorption and osteoformation.
Pamidronate treatment in patients with
Paget's disease of bone is effective and safe.