Brixen K, Steiniche T, Mosekilde L, Melsen F
Ugeskr Laeger. 1989 Mar 13;151(11):677-80.
Specific treatment of osteitis deformans (OD, Paget's disease of bone) is indicated when symptoms are associated with signs (biochemical or by bone scintigraphy) of active disease. OD in the base of the skull and osteolytic lesions in weight-bearing bones should be treated irrespective of symptoms. The effect of calcitonin (CT) on symptoms and skeletal blood-flow is achieved rapidly and healing of osteolytic lesions may occur. However, CT is only effective in approximately 60%, is discontinued due to side effect in 20% of patients, and must be administered parenterally. EHDP (Etidronate) is administered orally but the use of even small doses carries a risk of mineralisation defect and possibly fracture. EHDP should, therefore, be given intermittently and should not be used in osteolytic lesions of weight-bearing bones. Second-generation bisfofonates are devoid of this side effect and are very effective in OD. The effect of mithramycin is only transient and because of the risk of serious side effects the use should be restricted to severe cases of OD resistant to the other lines of treatment.
当症状与活动性疾病的体征（生化指标或骨闪烁显像）相关时，需对畸形性骨炎（OD，佩吉特骨病）进行特异性治疗。无论有无症状，颅骨底部的OD和承重骨的溶骨性病变均应予以治疗。降钙素（CT）对症状和骨骼血流的作用起效迅速，溶骨性病变可能愈合。然而，CT仅对约60%的患者有效，20%的患者因副作用而停药，且必须经胃肠外给药。依替膦酸二钠（EHDP）通过口服给药，但即使使用小剂量也有发生矿化缺陷及可能骨折的风险。因此，EHDP应间歇给药，且不应在承重骨的溶骨性病变中使用。第二代双膦酸盐没有这种副作用，在OD治疗中非常有效。光辉霉素的作用只是暂时的，由于存在严重副作用的风险，其使用应限于对其他治疗方法耐药的严重OD病例。
