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Indications for Bisphosphonate Treatment

CME

Paget Disease: When to Treat and When Not to Treat

  • Authors: Frederick R. Singer, MD
  • CME Released: 8/4/2009
  • THIS ACTIVITY HAS EXPIRED FOR CREDIT
  • Valid for credit through: 8/4/2010, 11:59 PM EST
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Target Audience and Goal Statement

This activity is intended for primary care physicians, orthopaedists, endocrinologists, rheumatologists, and other physicians who care for patients with Paget's disease.

The goal of this activity is to diagnose and treat Paget's disease effectively.

Upon completion of this activity, participants will be able to:

  • Identify elements of the clinical presentation of Paget's disease
  • Describe complications of Paget's disease
  • Specify the most potent bisphosphonate in the treatment of Paget's disease
  • Classify who should receive immediate treatment for Paget's disease


Disclosures

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MedscapeCME encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Author(s)

  • Frederick R. Singer, MD

    Director, Endocrine/Bone Disease Program, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, California; Clinical Professor of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California

    Disclosures

    Disclosure: Frederick R. Singer, MD, has disclosed that he has acted as a consultant for Amgen Inc. Dr. Singer has also disclosed that he has acted as a consultant to, been involved in speaker's bureaus for (honoraria), and has received grant/research support (including for clinical trials) from Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; and Procter & Gamble.

CME Author(s)

  • Charles P. Vega, MD, FAAFP

    Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine

    Disclosures

    Disclosure: Charles P. Vega, MD, FAAFP, has disclosed no relevant financial relationships.

Editor(s)

  • Jenny Buckland

    Editor, Nature Reviews Rheumatology

    Disclosures

    Disclosure: Jenny Buckland has disclosed no relevant financial relationships.


Accreditation Statements

    For Physicians

  • This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of MedscapeCME and Nature Publishing Group.

    MedscapeCME is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    MedscapeCME designates this educational activity for a maximum of 0.75 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity.

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For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit*:

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CME

Paget Disease: When to Treat and When Not to Treat

Authors: Frederick R. Singer, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME Released: 8/4/2009

Valid for credit through: 8/4/2010, 11:59 PM EST

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Abstract and Introduction

Abstract

Paget disease of bone is a focal disorder of the skeleton that can affect one or more bones. Many patients are discovered accidentally because of elevated serum alkaline phosphatase activity or an abnormal skeletal radiograph intended to evaluate an unrelated condition. Patients are often asymptomatic, but a subset experience considerable morbidity that can include bone pain and skeletal deformity, as well as a variety of regional complications, such as hearing loss associated with cranial involvement, degenerative arthritis of the hip or knee, fractures of the lower extremities and, rarely, sarcoma or giant cell tumors. Bisphosphonates have proven to be effective in controlling disease activity because they inhibit osteoclast function. Administration of these agents can relieve bone pain, decrease biochemical markers of bone resorption and bone formation, and retard or reverse the early osteolytic phase of the disease. Future studies are needed to determine whether these drugs, if used in an early stage of the disease, can prevent complications in asymptomatic patients.

Introduction

In 1877 sir James Paget published his classic study of patients he had seen with focal enlargement and de formity of the skeleton.[1] Later, with the advent of radiologic evaluation of the skeleton,[2] it was appreciated that the earliest phase of Paget disease was characterized by one or more focal osteolytic lesions, which developed over many years into sclerotic lesions that could then be detected on physical examination (Figure 1).

Figure 1.

Enlarge

Cortical changes in an untreated patient with Paget disease. Evolution of cortical changes in the left tibia on the lateral view of an untreated woman with Paget disease from age 45 to 68 years, as assessed by radiography. The arrows indicate the area of marked cortical thickening. The distal tibia appeared normal in 1964, but sclerotic changes progressively increased by 1987. Anterior bowing, which was mild in 1964, became progressively worse by 1987. Reproduced with permission from the American society for Bone and Mineral research © J. Bone Miner. Res. 12, 691–692 (1997).