Paget's disease

Some of the views expressed in the following notes on newly approved products should be regarded as preliminary, as there may have been limited published data at the time of publication, and little experience in Australia of their safety or efficacy. However, the Editorial Executive Committee believes that comments made in good faith at an early stage may still be of value. Before new drugs are prescribed, the Committee believes it is important that more detailed information is obtained from the manufacturer's approved product information, a drug information centre or some other appropriate source.

In Paget's disease bone resorption and formation are increased. Compared with osteoporosis, a higher dose is needed to control the activity of the disease. This activity can be assessed by measuring the serum alkaline phosphatose.

One study compared the effect of taking risedronate for two months with taking etidronate for six months. After 12 months, the concentrations of alkalinephosphatase were normal in 73% of the patients taking risedronate, but in only15% of those taking etidronate. Relapses were less common in the risedronate group. After 18 months, 53% of the group were still in remission compared with only 14% of the etidronate group. Risedronate also produced significant reductions in bone pain.2

Although risedronate has an advantage over etidronate so do other oral bisphosphonates such as alendronate and tiludronate. Further studies are needed to find the best bisphosphonate and to assess the safety of long-term treatment.


  1. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Effects of risedronate treatment on vertebral and nonvertebral fracturesin women with postmenopausal osteoporosis. JAMA 1999;282:1344-52.
  2. Miller PD, Brown JP, Siris ES, Hoseyni MS, Axelrod DW, Bekker PJ. A randomised, double-blind comparison of risedronate and etidronate in the treatment of Paget's disease of bone. Am J Med 1999;106:513-20.