How would you manage a middle-aged patient with Paget's disease who received one dose of zolendronic acid 2 years ago, currently suppressed CTX, normal bone-specific Alkaline phos, and a recent hairline fracture in the thoracic spine?

Parathyroid hormone analogs are, of course, contraindicated in patients with Paget's disease and I am not aware of any data regarding the use of romosozumab in patients with this condition. Paget's disease is primarily considered to be an osteoclast-related disorder and bisphosphonates, particularly zoledronic acid are very effective therapies with laboratory results similar to those seen in this case. There is no mention of whether the thoracic fracture was in an area of Pagetic involvement and...

I am not aware of any data on using anabolics in patients with Paget’s disease of the bone. With the theoretical concern of osteosarcoma, it was part of the label for tptd and abaloparatide to not give PTH anabolics to patients with Paget’s. Since there was a theoretical baseline increase in osteosarcoma with Paget’s, it made sense to avoid tptd and abaloparatide. Outside of the theoretical increased risk of osteosarcoma, I would worry that PTH anabolics could increase the activity of the Pageti...