Clinical experience with pamidronate in the treatment of Paget's disease of bone

Article Abstract:

In bone, a continual cycling process normally occurs, in which calcium salts are deposited within the structure, and then resorbed (removed). Bisphosphonates are chemicals that are structurally similar to pyrophosphate, a salt with a high affinity for calcium, and they inhibit bone resorption. Bone resorption is increased in Paget's disease of bone and in hypercalcemia (high blood calcium levels) proceeding from cancer, immobilization, and thyroid toxicity. Other drugs can also be used to treat Paget's disease, but they may cause toxicity, or resistance to the drug may develop. Other forms of bisphosphonates have been used, with varying side effects, but pamidronate appears to be both safe and effective in treating Paget's disease. To better estimate appropriate dosages, the outcome of intravenous pamidronate, given every three months, was compared with the effects of weekly infusions in 45 patients with Paget's disease. Blood levels of alkaline phosphatase (ALP), an enzyme associated with high levels of resorption, were measured. ALP levels decreased steadily in both groups over a year of treatment, but those treated weekly all reached close to normal range, while those treated every three months who initially had more severe disease did not improve as much. Patients reported decreased pain during treatment, and turnover of bone decreased significantly after the year of treatment. The study suggests that pamidronate given every three months is as effective in treatment of Paget's disease as weekly treatment, except in those with every severe disease, having levels of ALP more than fourfold over normal. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dosage and administration

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Cancer-associated hypercalcemia: morbidity and mortality: clinical experience in 126 treated patients

Article Abstract:

Hypercalcemia, or increased levels of calcium ions in the blood, is a common complication of cancer, and is associated with patient deterioration and death. While some believe that aggressive treatment of hypercalcemia is advisable, others suggest that since the hypercalcemia develops when the cancer is at an advanced stage, treatment is not necessary. Unfortunately, little research has documented the effects of treating hypercalcemia in these patients. To evaluate the effects of actively treating hypercalcemia, a retrospective study was conducted of the records of 126 patients with advanced cancer and hypercalcemia. Treatment did not result in increased survival, but there was substantial improvement in several symptoms. These symptoms included excessive urination, excessive thirst, nausea, vomiting, and loss of appetite, all of which improved in over half the cases. Central nervous system symptoms were reduced in 71 percent of the cases, and malaise and fatigue improved in 47 percent. Relief of these symptoms was correlated with the observed drop in blood calcium levels. These observations suggest that, while treating advanced patients for hypercalcemia is unlikely to improve survival, it is an effective palliative treatment which can relieve many symptoms. These improvements may permit advanced cancer patients to be discharged during the final stages of their illness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Research, Terminal care, Palliative care, Cancer, Cancer treatment, Hypercalcemia

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Treatment of Paget's disease of bone with single dose intravenous pamidronate

Article Abstract:

Single-dose intravenous (IV) pamidronate may be an effective treatment for Paget's disease of bone. Paget's disease of bone is a generalized skeletal disease of older persons in which bone resorption and formation are both increased. This can lead to thickening and softening of bone and bending of weight-bearing bones. Fourteen patients with Paget's disease of bone with elevated blood levels of alkaline phosphatase were infused with a single dosage of 105 milligrams of IV pamidronate. Ten patients had a decrease in their blood levels of alkaline phosphatase to within normal range. High blood levels alkaline phosphatase are associated with increased bone resorption. Among the 12 patients who initially had bone pain, nine had less pain six months after treatment. Four patients had a similar type of improvement after a second treatment with single-dose IV pamidronate.

Health aspects

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