Table 18.

Treating Symptoms or Increased Metabolic Activity with Bisphosphonates in PDB

Risk‐benefit balance

A strategy of intensive bisphosphonate therapy aimed at maintaining total ALP concentrations within the reference range performed similarly to a strategy of treatment with bisphosphonates and other drugs that aimed to control symptoms, with respect to the occurrence of clinical fractures, fractures through Pagetic bone, requirement for orthopedic surgery, quality of life, bone pain, and progression of hearing loss.

Quality of evidence

Moderate

Patient values and preferences

Prevention of fractures and orthopedic procedures, and improvements in bone pain, quality of life, and prevention of progressive hearing loss are all highly valued by patients.

Costs and use of resources

Bisphosphonates are inexpensive drugs, but intravenous therapy may involve additional support costs that may need to be considered. More frequent courses of therapy increase health care costs and resources as compared with less frequent courses of treatment.

Recommendation

Treatment aimed at improving symptoms is recommended over a treat‐to‐target strategy aimed at normalizing total ALP in PDB.