Kanis J A, Gray R E
Clin Orthop Relat Res. 1987 Apr(217):99-125.
The development of specific inhibitors of bone resorption has revolutionized the treatment of Paget's disease. The diphosphonates, the calcitonins, and mithramycin are capable of inducing marked suppression of disease activity for prolonged periods as judged by biochemical, kinetic, and histologic techniques. Whereas the effects of the calcitonins and mithramycin persist only for the duration of treatment, diphosphonate treatment consistently results in a reduction of disease activity for many months or even years after stopping treatment. The question arises whether the long-term control of the disease activity confers significant clinical advantages to the patient. Relief of bone pain, spinal neurologic syndromes, immobilization hypercalcemia, and high-output cardiac failure are related to the degree of biochemical control attained by treatment. New bone formed during treatment is lamellar and radiologic progression of disease is favorably modified. It is not yet known whether long-term treatment will decrease bone enlargement and deformity or reduce the risk of fracture.
骨吸收特异性抑制剂的研发彻底改变了佩吉特病的治疗方法。双膦酸盐、降钙素和光辉霉素能够通过生化、动力学和组织学技术判断，长期显著抑制疾病活动。降钙素和光辉霉素的作用仅在治疗期间持续，而双膦酸盐治疗在停止治疗后持续数月甚至数年始终能降低疾病活动度。问题在于疾病活动的长期控制是否能给患者带来显著的临床益处。骨痛、脊髓神经综合征、制动性高钙血症和高输出量心力衰竭的缓解与治疗所达到的生化控制程度有关。治疗期间形成的新骨是板层状的，疾病的放射学进展得到了有利改善。长期治疗是否会减少骨骼增大和畸形或降低骨折风险尚不清楚。
