Table 7.

Effect of Bisphosphonate Treatment on Bone Pain

Risk‐benefit balance

Bisphosphonates improve bone pain in PDB compared with placebo and comparative studies within bisphosphonates have shown that zoledronic acid is more likely to give an improvement than pamidronate and risedronate sodium. These bisphosphonates have a generally favourable adverse effect profile. In addition, most patients required other pain‐relieving medications such as analgesics and nonsteroidal anti‐inflammatory drugs for pain control.

Quality of evidence

Moderate

Patient values and preferences

Most patients that have bone pain are likely to favor the potential benefits of bisphosphonates with or without other analgesics considering their generally favorable adverse event profile.

Costs and use of resources

Bisphosphonates are inexpensive, but intravenous therapy involves additional support costs and costs in terms of patient time attending for the infusion that need to be considered.

Recommendation

Bisphosphonates are recommended for the treatment of bone pain associated with Paget's disease. Zoledronic acid is recommended as the bisphosphonate most likely to give a favorable pain response.