What monitoring strategies should be implemented for patients undergoing treatment for Paget's disease of bone?

Monitoring strategies for patients undergoing treatment for Paget's disease of bone primarily involve clinical assessment and biochemical monitoring to evaluate disease activity and treatment response.

• Regular measurement of serum alkaline phosphatase (ALP) is recommended as it reflects disease activity and response to treatment.
• Bone pain and deformity should be clinically assessed during follow-up to detect progression or complications.
• Imaging, such as X-rays or bone scans, may be used selectively to assess the extent of disease or complications but are not routinely required for monitoring treatment response.
• Monitoring for potential complications such as fractures or osteosarcoma should be part of clinical follow-up.
• Bone mineral density (BMD) assessment by dual-energy X-ray absorptiometry (DXA) may be considered if there is concern about osteoporosis or fracture risk, but it is not specific for Paget's disease activity.

These monitoring strategies should be tailored according to specialist advice and the clinical context of the patient, with primary care playing a role in ongoing assessment and communication with secondary care as needed.