Bone density changes in Paget's disease 2 years after iv pamidronate: Profound, sustained increases in pagetic bone with severity-related loss in forearm nonpagetic cortical bone

Gutteridge, D. H., Retallack, R. W., Ward, L. C., Price, R. I., Stewart, G. O., Stuckey, B. G. A., Prince, R. L., Kent, G. N., Bhagat, C. I. and Nicholson, G. C. (2003) Bone density changes in Paget's disease 2 years after iv pamidronate: Profound, sustained increases in pagetic bone with severity-related loss in forearm nonpagetic cortical bone. Bone, 32 1: 56-61. doi:10.1016/S8756-3282(02)00925-0


Author Gutteridge, D. H.
Retallack, R. W.
Ward, L. C.
Price, R. I.
Stewart, G. O.
Stuckey, B. G. A.
Prince, R. L.
Kent, G. N.
Bhagat, C. I.
Nicholson, G. C.
Title Bone density changes in Paget's disease 2 years after iv pamidronate: Profound, sustained increases in pagetic bone with severity-related loss in forearm nonpagetic cortical bone
Journal name Bone   Check publisher's open access policy
ISSN 8756-3282
Publication date 2003-01-01
Year available 2003
Sub-type Article (original research)
DOI 10.1016/S8756-3282(02)00925-0
Open Access Status Not Open Access
Volume 32
Issue 1
Start page 56
End page 61
Total pages 6
Place of publication Philadelphia, PA, United States
Publisher Elsevier
Language eng
Formatted abstract
Bone mineral density (BMD) was measured at three sites (forearm, spine, and hip) using dual X-ray and single-photon absorptiometry in 68 patients with Paget's disease before and after treatment with iv pamidronate. Patients were treated according to the severity of their disease; the mild category (Group I, hydroxyproline excretion (Hyp E) <5.0 μmol/L GF) received 120 mg, the moderate category (Group II, Hyp E 5.0-9.99 μmol/GF) 180 mg, and the severe category (Group III, ≥ 10.0 μmol/GF) 240 mg. Group I was followed for 1 year, and both Groups II and III for 2 years. At the lumbar spine in pagetic bone there were no differences between groups in early responses, with a profound increase 6 months after treatment 20.5 ± 2.0% above baseline values to 1.403 ± 0.063 g/cm 2 (mean ± SEM)(P < 0.001). This increase in BMD was sustained to 2 years (1.355 ± 0.078 g/cm 2, P < 0.001) and was 15.0 ± 2.2% above baseline values. The pagetic total hip BMD increased after treatment in all groups, with a mean rise of 10.4 ± 1.4% at 1 year to 1.505 ± 0.083 g/cm 2 (P < 0.01). At the pagetic femoral neck the response was similar, with a peak significant rise at 1 year of 10.7 ± 1.7% to 1.403 ± 0.097 g/cm 2 (P < 0.01). In nonpagetic spinal bone there were no differences between the group responses, with a combined mean increase of 4.3 ± 0.7% at 1 year to 0.999 ± 0.027 g/cm 2 (P < 0.01). In both Groups II and III the increase in BMD was significantly higher than baseline values at 1 and 2 years (P < 0.01). In the nonpagetic total hip BMD remained unchanged over the 2-year period and likewise, there were no significant changes from baseline at the nonpagetic femoral neck site. In the nonpagetic forearm we found a significant loss in BMD at the ultradistal (mainly trabecular), midregion (80% cortical), and proximal shaft (95% cortical) sites in Group III, persisting to 2 years at the latter two sites. The increase in bone density in pagetic bone, persisting at least 2 years, provides a new modality of assessment of the response of pagetic bone to treatment and suggests a mechanism for the reduction in fracture risk in such bone after effective bisphosphonate treatment. Severity-dependent nonpagetic forearm bone loss, persisting to 2 years at cortical sites, suggests a potential drug-induced fracture risk at the forearm and possibly elsewhere in the absence of appropriate preventive cotreatment.
Keyword Paget's disease
Pamidronate iv
Bone density
Pagetic bone
Nonpagetic bone
Fracture risk
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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