Summary:
In the submitted case-history the authors describe the clinical picture, diagnosis and treatment of
the non-complicated form of Paget´s disease in a 68-year-old patient with typical X-ray findings on
the vertebrae, pelvis and left tibia. The laboratory findings revealed liminal alkaline phosphatase
(ALP) values, 2.5 times raised values of the aminoterminal telopeptide of collagen I in the organic
bone matrix (NTx) in the 24-hour diuresis and slightly elevated osteocalcin (OSCA) levels. The
finding of whole-body skeletal scintigraphy was atypical and thus was no diagnostic asset. Aimed
transiliacal bone biopsy according to Bordier taken from the pathological focus confirmed the
diagnosis of morbus Paget.
The patient was treated for six months with the following preparations: Fosamax (monosodium
alendronate tablets a 10 mg, Merck Sharp and Dohme, USA) 1 tablet per day, Vitacalcin (calcium
carbonate , tablets a 250 mg elemental calcium, Slovakofarma, Slovak Republic) 2x1 tablet per
day, Rocaltrol (calcitriol tablets a 0.25 ug, Hoffman La Roche, Switzerland) 1 tablet on alternate
days).
Because of gastrointestinal complaints the authors did not administer 40 mg alendronate per day,
as recommended in the American literature. Based on the laboratory finding of normalization of
the bone turover, reduction of the number of osteoplastic foci on the X-ray image of vertebrae and
pelvis, regression of the vertebrogenic algic syndrome and improved mobility of the patient, the
authors consider the 6-month administration of alendronate, 10 mg per day, calcium carbonate
and calcitriol therapeutically effective and successful.
Key words:
Morbus Paget - Diagnosis - Therapy - Alendronate.
|