How do you approach a patient with Paget’s disease of bone with elevated alkaline phosphatase and history of chronic kidney disease?

You can give Zol IV, which is clearly the optimal treatment for active Paget's. Those in the field that treat many such patients just administer this very slowly over 1-2 hours and assure good hydration concomitantly. I have treated a number of patients like this, with this scenario, without any pro...

Tough one. I might try low-dose risedronate and monitor the calcium and creatinine values often.

Agree with Dr. @Dr. First Last. Not everyone with active Paget’s disease of bone needs pharmacologic treatment. The risks of treatment need to be carefully considered.

Clinical evaluation is important to assess the presence and extent of symptoms. If asymptomatic, it is not unreasonable to monitor without therapy given the risk of bisphosphonate use in stage 4 CKD. For symptomatic patients, oral bisphosphonates such as risedronate may be preferred in this specific...