Long-Term Efficacy of Intensive Zoledronate Therapy and Predictors of Retreatment in Paget’s Disease of Bone

Despite the current debate on the best therapeutic approach, i.e. symptomatic vs intensive strategy, one zoledronate (Zol) infusion is effective in most patients with Paget’s disease of bone (PDB), whereas few need retreatment, whose predictors are not well established. We aimed to evaluate long-ter...

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Bibliographic Details
Published in:Calcified tissue international 2021-10, Vol.109 (4), p.383-392
Main Authors: Barale, Marco, Sigrist, Sarah, Bioletto, Fabio, Maiorino, Federica, Ghigo, Ezio, Mazzetti, Riccardo, Procopio, Massimo
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Alkaline Phosphatase
Asymptomatic
Biochemistry
Biomedical and Life Sciences
Bone Density Conservation Agents - therapeutic use
Cell Biology
Diphosphonates
Disease control
Endocrinology
Female
Humans
Life Sciences
Male
Middle Aged
Multivariate analysis
Original Research
Orthopedics
Osteitis Deformans - drug therapy
Patients
Retreatment
Retrospective Studies
Statistical analysis
Zoledronic acid
Zoledronic Acid - therapeutic use
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Summary:Despite the current debate on the best therapeutic approach, i.e. symptomatic vs intensive strategy, one zoledronate (Zol) infusion is effective in most patients with Paget’s disease of bone (PDB), whereas few need retreatment, whose predictors are not well established. We aimed to evaluate long-term efficacy of intensive Zol therapy and predictors of retreatment in PDB. Pagetic complications, clinical and biochemical response to Zol together with frequency of retreatment were retrospectively assessed in forty-seven PDB patients (age, mean ± SD: 72.5 ± 8.9 years, M/F: 24/23; symptomatic/asymptomatic: 16/31). Statistical analysis for retreatment prediction were based on Mann–Whitney U test, Pearson’s Χ2 and ROC curve analysis. During seven-year follow-up, all patients achieved pain relief and only one underwent arthroplasty. Bone alkaline phosphatase (BAP) detected three non-responder (6%) and six relapsing (13%) patients needing retreatment. Retreated patients had less old age (66.1 ± 11.2 vs 74.0 ± 7.7 years), higher frequency of polyostotic disease (78% vs 40%) and higher baseline (96.5 ± 24.8 vs 44.9 ± 27.7 mcg/l) and post-Zol nadir BAP levels (24.7 ± 24.1 vs 8.1 ± 4.1 mcg/l) than patients treated once ( p  
ISSN:0171-967X
1432-0827
DOI:10.1007/s00223-021-00848-x