RT info:eu-repo/semantics/article
T1 Diagnosis and Management of Paget's Disease of Bone in Adults: A Clinical Guideline
A1 Ralston, Stuart H
A1 Corral Gudino, Luis
A1 Cooper, Cyrus
A1 Francis, Roger M
A1 Fraser, William D
A1 Gennari, Luigi
A1 Guañabens, Núria
A1 Javaid, M Kassim
A1 Layfield, Robert
A1 O'Neill, Terence W
A1 Russell, R Graham G
A1 Stone, Michael D
A1 Simpson, Keith
A1 Wilkinson, Diana
A1 Wills, Ruth
A1 Zillikens, M Carola
A1 Tuck, Stephen P
K1 ALP; ANTIRESORPTIVES; BISPHOSPHONATES; PAGET'S DISEASE OF BONE; RADIONUCLIDE BONE SCANS.
K1 3205 Medicina Interna
AB 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.
PB Wiley
SN 0884-0431
YR 2019
FD 2019
LK https://uvadoc.uva.es/handle/10324/65048
UL https://uvadoc.uva.es/handle/10324/65048
LA eng
NO Journal of Bone and Mineral Research, Abril 2019, vol. 34, n. 4, p. 579-604
NO Producción Científica
DS UVaDOC
RD 26-jun-2024