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Long-term control of bone turnover in Paget's disease with zoledronic acid and risedronate.
J Bone Miner Res. 2007 Jan; 22(1):142-8.JB

Abstract

A single 5-mg infusion of zoledronic acid restores biochemical markers of bone turnover into the reference range in the majority of patients with Paget's disease and maintains biochemical remission for at least 2 years. This effect is largely independent of pretreatment disease activity and prior bisphosphonate therapy.

INTRODUCTION

Zoledronic acid (ZOL) is a potent bisphosphonate that produces a rapid and complete control of the increased bone turnover of Paget's disease. Long-term control of disease activity is an important aim of treatment in the hope that this will reduce the risk of complications such as deformity, fracture, and degenerative joint disease.

MATERIALS AND METHODS

This study compares the ability of ZOL 5 mg given as a 15-minute intravenous infusion with risedronate (RIS) 30 mg daily by mouth for 60 days to maintain long-term control of bone turnover. No bisphosphonate was given during the extension study. All patients (n = 296) who achieved a therapeutic response, defined as normalization or a >75% reduction in the total alkaline phosphatase (total ALP) excess above the midpoint of the reference range, were eligible for inclusion.

RESULTS

ZOL maintained the mean level of total ALP at the middle of the reference range, whereas those treated with risedronate showed a linear increase in total ALP from the 6-month post-treatment time-point. Both treatments resulted in a linear relationship between the 6-month nadir and 24-month total ALP. The relationship for RIS was shifted upward, showing that for a given level of post-treatment biochemical activity, bone turnover increased with time. This was in contrast to the ZOL-treated patients where total ALP generally remained unchanged over this 18-month extension period. A similar pattern of response was seen with the other bone turnover markers.

CONCLUSIONS

ZOL maintains bone turnover within the reference range over 24 months from the initiation of treatment. A reduction in the incidence and severity of long-term complications may require persistent normalization of bone turnover over many years, and this now seems a realistic possibility with ZOL.

Authors+Show Affiliations

City Hospital, Nottingham, UK. david.hosking@nuh.nhs.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17032148

Citation

Hosking, David, et al. "Long-term Control of Bone Turnover in Paget's Disease With Zoledronic Acid and Risedronate." Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, vol. 22, no. 1, 2007, pp. 142-8.
Hosking D, Lyles K, Brown JP, et al. Long-term control of bone turnover in Paget's disease with zoledronic acid and risedronate. J Bone Miner Res. 2007;22(1):142-8.
Hosking, D., Lyles, K., Brown, J. P., Fraser, W. D., Miller, P., Curiel, M. D., Devogelaer, J. P., Hooper, M., Su, G., Zelenakas, K., Pak, J., Fashola, T., Saidi, Y., Eriksen, E. F., & Reid, I. R. (2007). Long-term control of bone turnover in Paget's disease with zoledronic acid and risedronate. Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, 22(1), 142-8.
Hosking D, et al. Long-term Control of Bone Turnover in Paget's Disease With Zoledronic Acid and Risedronate. J Bone Miner Res. 2007;22(1):142-8. PubMed PMID: 17032148.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term control of bone turnover in Paget's disease with zoledronic acid and risedronate. AU - Hosking,David, AU - Lyles,Kenneth, AU - Brown,Jacques P, AU - Fraser,William D, AU - Miller,Paul, AU - Curiel,Manuel Diaz, AU - Devogelaer,Jean-Pierre, AU - Hooper,Michael, AU - Su,Guoqin, AU - Zelenakas,Ken, AU - Pak,Judy, AU - Fashola,Taiwo, AU - Saidi,Youssef, AU - Eriksen,Erik Fink, AU - Reid,Ian R, PY - 2006/10/13/pubmed PY - 2007/7/17/medline PY - 2006/10/13/entrez SP - 142 EP - 8 JF - Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research JO - J Bone Miner Res VL - 22 IS - 1 N2 - UNLABELLED: A single 5-mg infusion of zoledronic acid restores biochemical markers of bone turnover into the reference range in the majority of patients with Paget's disease and maintains biochemical remission for at least 2 years. This effect is largely independent of pretreatment disease activity and prior bisphosphonate therapy. INTRODUCTION: Zoledronic acid (ZOL) is a potent bisphosphonate that produces a rapid and complete control of the increased bone turnover of Paget's disease. Long-term control of disease activity is an important aim of treatment in the hope that this will reduce the risk of complications such as deformity, fracture, and degenerative joint disease. MATERIALS AND METHODS: This study compares the ability of ZOL 5 mg given as a 15-minute intravenous infusion with risedronate (RIS) 30 mg daily by mouth for 60 days to maintain long-term control of bone turnover. No bisphosphonate was given during the extension study. All patients (n = 296) who achieved a therapeutic response, defined as normalization or a >75% reduction in the total alkaline phosphatase (total ALP) excess above the midpoint of the reference range, were eligible for inclusion. RESULTS: ZOL maintained the mean level of total ALP at the middle of the reference range, whereas those treated with risedronate showed a linear increase in total ALP from the 6-month post-treatment time-point. Both treatments resulted in a linear relationship between the 6-month nadir and 24-month total ALP. The relationship for RIS was shifted upward, showing that for a given level of post-treatment biochemical activity, bone turnover increased with time. This was in contrast to the ZOL-treated patients where total ALP generally remained unchanged over this 18-month extension period. A similar pattern of response was seen with the other bone turnover markers. CONCLUSIONS: ZOL maintains bone turnover within the reference range over 24 months from the initiation of treatment. A reduction in the incidence and severity of long-term complications may require persistent normalization of bone turnover over many years, and this now seems a realistic possibility with ZOL. SN - 0884-0431 UR - https://www.unboundmedicine.com/medline/citation/17032148/Long_term_control_of_bone_turnover_in_Paget's_disease_with_zoledronic_acid_and_risedronate_ L2 - https://doi.org/10.1359/jbmr.061001 DB - PRIME DP - Unbound Medicine ER -