The University of Southampton
University of Southampton Institutional Repository
Warning ePrints Soton is experiencing an issue with some file downloads not being available. We are working hard to fix this. Please bear with us.

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.
1edc2a3a-ef8d-459d-a9a2-d7ef14462d2b
Corral-Gudino, Luis
6c3b4810-efdc-4adb-94b0-ae1db1c9ac27
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Francis, Roger M.
f416d4e8-0b7e-4b3a-9c08-c118c0f6b6c9
Fraser, William D.
82e0b6be-d227-4e83-b61e-e66231131615
Gennari, Luigi
945bd17b-0469-45e3-b302-5c97ce2997c5
Guanabens, Nuria
b77462c8-8f26-4de0-a2de-f81d6d9352d3
Javaid, Kassim
69bf78c2-9bb1-48b8-8c26-157a823b3421
Layfield, Robert
c835d413-9875-4414-8f8f-8bf68444682d
O'Neill, Terence W
b40358f0-5719-41f9-9855-0814aa9af4b5
Russell, R. Graham G.
055e01f6-6175-4437-aaa0-a78659799dca
Stone, Michael D.
4759f7b3-bba0-4010-899e-5c59a599bc17
Simpson, Keith
39ac5412-7544-4fda-8a18-22fcdec9874b
Wilkinson, Diana
89ff5951-48ab-4bf3-9b35-88ded4d4cb4a
Wills, Ruth
2c13e86e-e43c-444b-a9f4-3e8e46dd4a18
Zillikens, M Carola
c0b40566-14df-4e71-b840-8ae51d177acc
Tuck, Stephen P.
54081da9-2f89-4dca-9133-e7bc83fec46a
Ralston, Stuart H.
1edc2a3a-ef8d-459d-a9a2-d7ef14462d2b
Corral-Gudino, Luis
6c3b4810-efdc-4adb-94b0-ae1db1c9ac27
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Francis, Roger M.
f416d4e8-0b7e-4b3a-9c08-c118c0f6b6c9
Fraser, William D.
82e0b6be-d227-4e83-b61e-e66231131615
Gennari, Luigi
945bd17b-0469-45e3-b302-5c97ce2997c5
Guanabens, Nuria
b77462c8-8f26-4de0-a2de-f81d6d9352d3
Javaid, Kassim
69bf78c2-9bb1-48b8-8c26-157a823b3421
Layfield, Robert
c835d413-9875-4414-8f8f-8bf68444682d
O'Neill, Terence W
b40358f0-5719-41f9-9855-0814aa9af4b5
Russell, R. Graham G.
055e01f6-6175-4437-aaa0-a78659799dca
Stone, Michael D.
4759f7b3-bba0-4010-899e-5c59a599bc17
Simpson, Keith
39ac5412-7544-4fda-8a18-22fcdec9874b
Wilkinson, Diana
89ff5951-48ab-4bf3-9b35-88ded4d4cb4a
Wills, Ruth
2c13e86e-e43c-444b-a9f4-3e8e46dd4a18
Zillikens, M Carola
c0b40566-14df-4e71-b840-8ae51d177acc
Tuck, Stephen P.
54081da9-2f89-4dca-9133-e7bc83fec46a

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.

Text
Diagnosis and Management of Paget JBMR Rev 3 051218 - Accepted Manuscript
Download (918kB)
Text
Ralston_et_al-2019-Journal_of_Bone_and_Mineral_Research - Version of Record
Available under License Creative Commons Attribution.
Download (1MB)
Text
Diagnosis and Management of PDB Supplementary Material JBMR Rev 3 051218
Restricted to Repository staff only
Request a copy

More information

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

Catalogue record

Date deposited: 06 Mar 2019 17:30
Last modified: 26 Nov 2021 05:50

Export record

Altmetrics

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

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×