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Diagnosis and management of Paget's disease of bone in adults: a clinical guideline

Diagnosis and management of Paget's disease of bone in adults: a clinical guideline
Diagnosis and management of Paget's disease of bone in adults: a clinical guideline
An evidence‐based clinical guideline for the diagnosis and management of Paget's disease of bone (PDB) was developed using GRADE methodology, by a Guideline Development Group (GDG) led by the Paget's Association (UK). A systematic review of diagnostic tests and pharmacological and nonpharmacological treatment options was conducted that sought to address several key questions of clinical relevance. Twelve recommendations and five conditional recommendations were made, but there was insufficient evidence to address eight of the questions posed. The following recommendations were identified as the most important: 1) Radionuclide bone scans, in addition to targeted radiographs, are recommended as a means of fully and accurately defining the extent of metabolically active disease in patients with PDB. 2) Serum total alkaline phosphatase (ALP) is recommended as a first‐line biochemical screening test in combination with liver function tests in screening for the presence of metabolically active PDB. 3) Bisphosphonates are recommended for the treatment of bone pain associated with PDB. Zoledronic acid is recommended as the bisphosphonate most likely to give a favorable pain response. 4) Treatment aimed at improving symptoms is recommended over a treat‐to‐target strategy aimed at normalizing total ALP in PDB. 5) Total hip or knee replacements are recommended for patients with PDB who develop osteoarthritis in whom medical treatment is inadequate. There is insufficient information to recommend one type of surgical approach over another. The guideline was endorsed by the European Calcified Tissues Society, the International Osteoporosis Foundation, the American Society of Bone and Mineral Research, the Bone Research Society (UK), and the British Geriatric Society. The GDG noted that there had been a lack of research on patient‐focused clinical outcomes in PDB and identified several areas where further research was needed.
0884-0431
Ralston, Stuart H.
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Corral-Gudino, Luis
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Cooper, Cyrus
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Francis, Roger M.
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Fraser, William D.
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Gennari, Luigi
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Guanabens, Nuria
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Javaid, Kassim
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Layfield, Robert
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O'Neill, Terence W
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Russell, R. Graham G.
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Stone, Michael D.
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Simpson, Keith
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Wilkinson, Diana
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Wills, Ruth
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Zillikens, M Carola
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Tuck, Stephen P.
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Ralston, Stuart H.
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Corral-Gudino, Luis
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Cooper, Cyrus
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Francis, Roger M.
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Fraser, William D.
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Gennari, Luigi
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Guanabens, Nuria
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Javaid, Kassim
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Layfield, Robert
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O'Neill, Terence W
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Russell, R. Graham G.
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Stone, Michael D.
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Simpson, Keith
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Wilkinson, Diana
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Wills, Ruth
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Zillikens, M Carola
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Tuck, Stephen P.
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Ralston, Stuart H., Corral-Gudino, Luis, Cooper, Cyrus, Francis, Roger M., Fraser, William D., Gennari, Luigi, Guanabens, Nuria, Javaid, Kassim, Layfield, Robert, O'Neill, Terence W, Russell, R. Graham G., Stone, Michael D., Simpson, Keith, Wilkinson, Diana, Wills, Ruth, Zillikens, M Carola and Tuck, Stephen P. (2019) Diagnosis and management of Paget's disease of bone in adults: a clinical guideline. Journal of Bone and Mineral Research, [e3657]. (doi:10.1002/jbmr.3657).

Record type: Article

Abstract

An evidence‐based clinical guideline for the diagnosis and management of Paget's disease of bone (PDB) was developed using GRADE methodology, by a Guideline Development Group (GDG) led by the Paget's Association (UK). A systematic review of diagnostic tests and pharmacological and nonpharmacological treatment options was conducted that sought to address several key questions of clinical relevance. Twelve recommendations and five conditional recommendations were made, but there was insufficient evidence to address eight of the questions posed. The following recommendations were identified as the most important: 1) Radionuclide bone scans, in addition to targeted radiographs, are recommended as a means of fully and accurately defining the extent of metabolically active disease in patients with PDB. 2) Serum total alkaline phosphatase (ALP) is recommended as a first‐line biochemical screening test in combination with liver function tests in screening for the presence of metabolically active PDB. 3) Bisphosphonates are recommended for the treatment of bone pain associated with PDB. Zoledronic acid is recommended as the bisphosphonate most likely to give a favorable pain response. 4) Treatment aimed at improving symptoms is recommended over a treat‐to‐target strategy aimed at normalizing total ALP in PDB. 5) Total hip or knee replacements are recommended for patients with PDB who develop osteoarthritis in whom medical treatment is inadequate. There is insufficient information to recommend one type of surgical approach over another. The guideline was endorsed by the European Calcified Tissues Society, the International Osteoporosis Foundation, the American Society of Bone and Mineral Research, the Bone Research Society (UK), and the British Geriatric Society. The GDG noted that there had been a lack of research on patient‐focused clinical outcomes in PDB and identified several areas where further research was needed.

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Diagnosis and Management of Paget JBMR Rev 3 051218 - Accepted Manuscript
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Accepted/In Press date: 8 December 2018
e-pub ahead of print date: 25 February 2019

Identifiers

Local EPrints ID: 428676
URI: http://eprints.soton.ac.uk/id/eprint/428676
ISSN: 0884-0431
PURE UUID: 4007abb9-1f55-4b87-beb4-cdc321f41899
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 06 Mar 2019 17:30
Last modified: 11 May 2024 04:02

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Contributors

Author: Stuart H. Ralston
Author: Luis Corral-Gudino
Author: Cyrus Cooper ORCID iD
Author: Roger M. Francis
Author: William D. Fraser
Author: Luigi Gennari
Author: Nuria Guanabens
Author: Kassim Javaid
Author: Robert Layfield
Author: Terence W O'Neill
Author: R. Graham G. Russell
Author: Michael D. Stone
Author: Keith Simpson
Author: Diana Wilkinson
Author: Ruth Wills
Author: M Carola Zillikens
Author: Stephen P. Tuck

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