Treatment of patients with Paget's disease of bone

Paget's disease is a progressive bone disease, monostotic or polyostotic, characterised by hypertrophy of affected bones and accelerated disorganised bone remodelling. It results in bone deformities and pain, with a risk for articular and neurological complications, and fractures. The risk of complications, and thus the therapeutic decision, is it function of the age of the patient, and the severity and the activity of the disease. Bisphosphonates are first-line therapy for Paget's disease, and the advent of the new bisphosphonates permits a dramatic improvement in treatment. The optimal treatment regimen should obtain normalisation or quasi-normalisation of markers of bone remodelling. This result has the potential for a long-term control of the disease.