Response to Zoledronic Acid in Patients with Active Paget's Disease of Bone: A Retrospective Study.

Background: Traditionally, bisphosphonates are used to treat active Paget's disease of bone (PDB). Intravenous zoledronic acid (ZA) is the most effective treatment option leading to sustained remission.

Objective: The primary objective of this study was to analyze the effect of intravenous ZA in patients with active PDB in a tertiary care center of India.

Materials And Methods: Retrospective data of 13 patients with active PDB who received a single dose of 4 mg intravenous ZA at our institute from January 2011 to June 2017 were reviewed. Response to therapy was monitored clinically, biochemically by serum alkaline phosphatase (ALP), and scintigraphically by 99m-Technetium methylene diphosphonate bone scan.

Results: All of our patients reported relief of bone pain. The mean duration of follow-up in our study was 35.2 ± 16.8 months. Serum ALP levels reduced significantly from 1190.9 ± 666.1 IU/L ( = 13) at baseline to 200.5 ± 68.4 IU/L ( = 13) at 6 months ( < 0.001). ALP level at 1 year was 174 ± 33.6 IU/L ( = 12), which remained stable till 36 months at 176.5 ± 50 IU/L ( = 8). This indicates that remission achieved by 6 months post ZA is sustained for at least 3 years. Scintigraphic ratio reduced from 9.6 [interquartile range (IQR) 5.25-18.2] at baseline to 2.7 (IQR 1.20-4.05) at follow-up ( < 0.001). Similarly, scintigraphic index of involvement reduced from 9.9 (IQR 5.6-28.5) at baseline to 3 (IQR 2-4) at follow-up ( = 0.018).

Conclusion: A 4 mg single dose of intravenous ZA results in clinical, biochemical, and scintigraphic response that is sustained for at least 3 years.