Paget disease of bone
Focal high-turnover bone disease of older adults. Suspect it from an isolated raised ALP, confirm with X-ray and define extent with a bone scan, and treat bone pain with a single 5 mg infusion of zoledronic acid after replacing vitamin D.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Focal disorder of excessive osteoclast activity with disorganised new bone. The bone is larger, weaker and more vascular than normal.
- Over 55s, more common in people of British descent. Australia and New Zealand have relatively high rates, though incidence and severity have fallen over decades.
- Usually found by chance: an isolated raised ALP or an X-ray done for something else.
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Sources
- Ralston SH, Corral-Gudino L, Cooper C et al. Diagnosis and management of Paget's disease of bone in adults: a clinical guideline. J Bone Miner Res 2019;34:579-604Paget's Association (endorsed by ECTS, IOF, ASBMR, Bone Research Society, British Geriatrics Society), 2019 (current; no later update found, November 2026)
- Singer FR, Bone HG, Hosking DJ et al. Paget's disease of bone: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2014;99:4408-22Endocrine Society, 2014
- Reid IR, Miller P, Lyles K et al. Comparison of a single infusion of zoledronic acid with risedronate for Paget's disease. N Engl J Med 2005;353:898-908New England Journal of Medicine, 2005
- Langston AL, Campbell MK, Fraser WD et al. Randomized trial of intensive bisphosphonate treatment versus symptomatic management in Paget's disease of bone (PRISM). J Bone Miner Res 2010;25:20-31Journal of Bone and Mineral Research, 2010
- Phillips J, Subedi D, Lewis SC et al. Randomised trial of genetic testing and targeted intervention to prevent the development and progression of Paget's disease of bone (ZiPP). Ann Rheum Dis 2024;83:529-36Annals of the Rheumatic Diseases, 2024
- Zoledronic acid 5 mg/100 mL, PBS listing for symptomatic Paget disease of bone (Authority Required, streamlined)AU/NZPharmaceutical Benefits Scheme, checked November 2026
- Endocrinology (Therapeutic Guidelines)AU/NZTherapeutic Guidelines Ltd
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback