Vnitr Lek 1999, 45(10):602-605

[Paget's disease of bone--treatment with alendronate, calcium and calcitriol].

J Wendlová, S Galbavý, J Paukovic: Osteologická ambulancia, Fakultná nemocnica s poliklinikou akad. L. Dérera, Bratislava.

In the submitted case-history the authors describe the clinical picture, diagnosis and treatment of the non-complicated form of Paget's disease in a 68-year-old patient with typical X-ray findings on the vertebrae, pelvis and left tibia. The laboratory findings revealed liminal alkaline phosphatase (ALP) values, 2.5 times raised values of the aminoterminal telopeptide of collagen I in the organic bone matrix (NTx) in the 24-hour diuresis and slightly elevated osteocalcin (OSCA) levels. The finding of whole-body skeletal scintigraphy was atypical and thus was no diagnostic asset. Aimed transiliacal bone biopsy according to Bordier taken from the pathological focus confirmed the diagnosis of morbus Paget. The patient was treated for six months with the following preparations: Fosamax (monosodium alendronate tablets a 10 mg, Merck Sharp and Dohme, USA) 1 tablet per day, Vitacalcin (calcium carbonate, tablets a 250 mg elemental calcium, Slovakofarma, Slovak Republic) 2 x 1 tablet per day, Rocaltrol (calcitriol tablets a 0.25 ug, Hoffman La Roche, Switzerland) 1 tablet on alternate days). Because of gastrointestinal complaints the authors did not administer 40 mg alendronate per day, as recommended in the American literature. Based on the laboratory finding of normalization of the bone turnover, reduction of the number of osteoplastic foci on the X-ray image of vertebrae and pelvis, regression of the vertebrogenic algic syndrome and improved mobility of the patient, the authors consider the 6-month administration of alendronate, 10 mg per day, calcium carbonate and calcitriol therapeutically effective and successful.