Paget disease of bone — SCE Rheumatology MCQ

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ModerateMetabolic Bone DiseasePaget disease of boneSCE Rheumatology

A 70-year-old woman has symptomatic Paget disease affecting the pelvis with ALP three times the upper limit of normal. Renal function is normal and dental review shows no planned extractions. She has pain localised to the Pagetic bone. What is the most appropriate management?

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Correct answer: D — Give intravenous zoledronic acid

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · C = shown as D

Give intravenous zoledronic acid is best because symptomatic active Paget disease is treated effectively with bisphosphonate therapy, often intravenous zoledronic acid. A is less suitable because hydroxychloroquine is used in SLE/RA and not Paget disease; B is less suitable because rituximab has no role in Paget disease; D is less suitable because prednisolone is not Paget therapy; E is less suitable because methotrexate treats inflammatory arthritis. Clinical pearl: Paget treatment aims to suppress high bone turnover and improve bone pain.

Reference: Endocrine Society Paget guideline; BNF