# Radiological impact of oral bisphosphonate use on polyostotic Paget's disease of bone over a 2 year period

## TL;DR

A South-Asian man with Paget's disease showed limited response to bisphosphonate treatment despite normal blood markers.

## Contribution

Highlights potential limitations of using metabolic markers alone to manage Paget's disease.

## Key findings

- Patient had normal alkaline phosphatase levels but still experienced vertebral fractures.
- Oral bisphosphonates were ineffective in preventing fractures despite biochemical remission.
- Suggests radiological monitoring may be necessary alongside metabolic markers.

## Abstract

Paget's disease of bone is a disorder of osteoclasts which hampers the physiological process of bone remodeling. It is the most common metabolic orthopedic disease in the Caucasian populace; we report the diagnosis of Paget's disease of bone in a South-Asian male in his early 50s with a history of gastrointestinal symptoms, weight loss and back pain. An alkaline phosphatase level of 1104 IU/L was noted. A 3-phase bone scan showed noncontiguous heterogenous nuclear uptake. After exhaustive evaluation, the patient was diagnosed with Paget's disease of bone. Despite the disease activity being mitigated by alendronate and monitored by ALP levels within normal range per protocol, the patient had compression fractures of the vertebrae requiring early reinitiation of oral bisphosphonates. This raised doubts about the efficacy of metabolic marker-based management in Paget's disease of bone.