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Treatment of Paget's disease of bone traditionally has been limited to patients with severe disease, defined as serum alkaline phosphatase levels of more than two times the upper limit of normal, bone pain not responsive to analgesics and higher risk for complications such as fracture. Newer antiresorptive treatments, including pamidronate, alendronate, tiludronate and etidronate, offer more widespread therapeutic intervention and shorter treatment courses. Risedronate is a pyridinyl bisphosphonate that is about 1,000 times more potent than etidronate and three to five times more potent than alendronate. These attributes allow for a shorter duration of treatment at a lower dosage. Miller and associates compared the effectiveness of risedronate with that of etidronate in the treatment of Paget's disease of bone.
Patients with documented Paget's disease were included if their serum alkaline phosphatase levels were at least two times the upper limit of normal. Women were required to...