Session Information
Session Title: AA 2021 Virtual Posters - Pain and Spine Medicine
Session Time: None. Available on demand.
Disclosures: Andrew C. Wondra, MD: No financial relationships or conflicts of interest
Case Diagnosis: Complete resolution of familial Paget’s disease and associated pain with a single zoledronic acid infusion.
Case Description: Patient #1, a 63-year-old man presented with left knee pain and family history significant for Paget’s disease in his mother and maternal aunt. X-ray demonstrated an abnormal appearance of the left lateral femoral condyle, and magnetic resonance demonstrated an ill-defined heterogeneous enhancement of the marrow within the lateral femoral condyle with cortical trabecular thickening. He was treated with oral Fosamax for nearly one year without improvement. Patient #2, 53-year-old women with chronic low back pain underwent a bone scan for an elevated ALP and was consistent with pagetic changes of the left iliac, sacral and acetabular osseous structures. Her family history is significant for Paget’s disease in her maternal grandmother. Both patients presented with significantly elevated alkaline phosphatase (ALP) levels and were treated with a single 5-milligram zoledronic acid infusion.
Setting: Outpatient Physiatry ClinicAssessment/
Results: Both patients had significantly elevated levels and bone pain related to Paget’s disease and were treated with a single zoledronic acid infusion, resulting in the normalization of ALP levels and significant reductions in bone pain. Patient #1 has not had an increase in ALP levels or bone pain for over 4.5 years. Patient #2 has seen the same immediate benefit and will be followed over the coming years.
Discussion: Zoledronic acid is a potent nitrogen-containing bisphosphonate that is thought to suppress the dysfunctional osteoclast activity that underlies Paget’s disease. This is one of a few, if any, unique case series detailing the effects of a single zoledronic acid infusion in treating the familial form of Paget’s disease to achieve remission long-term.
Conclusion: A single infusion of zoledronic acid should be considered in patients with familial Paget’s disease to normalize elevated alkaline phosphatase levels, improve bone pain, and achieve long-term remission.
Level of Evidence: Level V
To cite this abstract in AMA style:
Wondra AC, Bunning RD, Druckenbrod M. Familial Paget’s Disease and Associated Pain Treated with a Single Zoledronic Acid Infusion: Case Series [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/familial-pagets-disease-and-associated-pain-treated-with-a-single-zoledronic-acid-infusion-case-series/. Accessed May 30, 2025.« Back to AAPM&R Annual Assembly 2021
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/familial-pagets-disease-and-associated-pain-treated-with-a-single-zoledronic-acid-infusion-case-series/