Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0151825 (bone pain)
 3,118 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The activity of a therapeutic drug against Paget's disease is judged by a reduction in the level of hydroxyprolinuria and of alkaline phosphatasaemia, these being the metabolic signs of the bone changes, and by a decrease in bone pain which may accompany the bone changes in Paget's disease. The effect of aspirin is only moderate and is produced only with large doses that are often not well tolerated. The cortisone drugs are also active only at high doses that should be avoided. The action of sodium fluoride is uncertain. Mithramycin is always effective; it leads to a decrease in the levels of hydroxyprolinuria and of alkaline phosphatosaemia and to disappearance of the pain. At the dose levels used by the authors, mithramycin induces only certain metabolic anomalies (rise in transaminases, decrease in the prothrombin level...) which return to normal at the end of treatment. However, the long-term tolerance of mithramycin is unknown and the authors think that its use in cases of Paget's disease should be severely restricted. Sodium etidronate, a diphosphonate that inhibits both bone resorption and osteoformation also decreases regularly the levels of hydroxyprolinuria and of alkaline phosphatasemia and often decreases the pain. It is usually well tolerated. However at the dose rate of 20 mg/kg/day it may lead to the development of osteomalacia.
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PMID:[Non-hormonal drug treatment in Paget's disease]. 13 65

Subjects (109) with symptomatic Paget's disease of bone were treated with 5, 10, or 20 mg of sodium etidronate (EHDP)/kg body weight - day for 6 to 24 months. Significant decreases in serum alkaline phosphatase and urinary hydroxyproline were noted after 6 months of therapy; no significant further improvement resulted after prolonged therapy. Some patients maintained biochemical remission after withdrawal of EHDP but others showed a relapse, related primarily to the pretreatment severity. Clinical improvement was noted in 61% of the patients. Similar findings were seen after a second course of EHDP. No side-effects were noted in patients treated with 5 mg of EHDP/kg body weight - day. In patients treated with 10 or 20 mg of EHDP/kg body weight - day, severe diarrhea, bone pain, and nontraumatic fractures were noted in 3, 13, and 12 patients respectively. Quantitative histomorphometry showed mineralization delay in patients receiving 10 or 20 mg of EHDP/kg body weight - day but not in those receiving 5 mg/kg body weight - day. Five milligrams of EHDP/kg body weight - day was effective and appears to be safer than the higher doses.
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PMID:Sodium etidronate in the treatment of Paget's disease of bone. A study of long-term results. 41 50

Sodium etidronate is a diphosphonate compound that inhibits bone resorption and mineralization. The drug has been reported to be highly effective for the palliation of painful bone metastasis from prostatic cancer. Fifty-seven patients were entered into a randomized, prospective, double-blind, placebo-controlled study of sodium etidronate. All patients had hormone refractory metastatic prostatic cancer and bone pain requiring analgesics. No difference was seen in the symptomatic response rate or analgesic requirement between patients treated with sodium etidronate and placebo. With the dose scheme used in this study sodium etidronate was ineffective for palliation of bone pain from prostatic cancer.
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PMID:Palliation of painful bone metastases from prostate cancer using sodium etidronate: results of a randomized, prospective, double-blind, placebo-controlled study. 246 69

Paget's disease of bone is often discovered incidentally, but can have extensive metabolic and local mechanical complications. Treatment is not required for all patients and should only be undertaken for certain indications, and with a clear understanding of the three types of drugs available. Bone pain unmanageable with analgesics and pathologic fractures are the most common indications, while neurologic symptoms, hypercalcemia and congestive heart failure are less frequent ones. Calcitonin or mithramycin is used for the more urgent indications, and calcitonin or the diphosphonate, etidronate sodium (EHDP), for the more chronic ones. The drugs are generally efficacious and well tolerated.
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PMID:Paget's disease of bone: clinical features and treatment. 315 5

This multicenter, double-blind, randomized, parallel study compared the efficacy and safety of two dosages of naproxen sodium (NS) in 100 patients with bone pain due to metastatic cancer. Patients were asked to rate their pain on a scale of 0-99; those patients with pain scores of 40 or more (indicating moderate to severe pain) were enrolled. Patients receiving the high-dosage regimen (HDR; n = 51) received NS 550 mg every 8 h for 3 days. Those receiving the low-dosage regimen (LDR; n = 49) received on day 1 an initial dose of NS 550 mg followed by NS 275 mg capsules every 8 h through day 3. Patients evaluated pain intensity 8 times/day. During use of NS, pain intensity scores decreased by approximately one-third in each treatment group. Among patients who responded to NS, pain relief with the HDR was significantly greater than with the LDR. Differences between regimens in adverse events during treatment were non-significant; complaints were mainly gastrointestinal and mild.
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PMID:Naproxen sodium in treatment of bone pain due to metastatic cancer. 322 54

Fibrogenesis imperfecta ossium is a rare, acquired disorder of bone mineralization characterized by a morphologic abnormality of bone collagen that presents with bone pain and tenderness and usually results in the patient becoming bedridden. Onset of symptoms in the six previously reported cases of this disorder occurred in patients over 50 years of age. We report a case of fibrogenesis imperfecta ossium with symptoms starting at age 39 where the diagnosis was not made even after three bone biopsies because of the failure to recognize the characteristic morphologic abnormality of collagen. Elevated serum alkaline phosphatase, increased urinary hydroxyproline, and numerous osteoclasts on a bone biopsy are compatible with increased bone turnover. There was no apparent abnormality of vitamin D metabolism contributing to this disorder. Treatment with sodium fluoride, synthetic salmon calcitonin, and 24,25-dihydroxyvitamin D did not result in any apparent benefit.
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PMID:Fibrogenesis imperfecta ossium with early onset: observations after 20 years of illness. 349 Feb 68

18 patients with Paget's disease have received 27 courses of mithramycin therapy. This treatment has proved to be very effective in rapidly relieving bone pain due to Paget's disease--relief being apparent in 4 to 5 days. A dose of 10 micrograms/kg/day for 10 days is effective, well tolerated and to date free of serious side effects. Such treatment is particularly indicated in complicated cases with other possible explanations for the pain. Long term relief is unusual unless calcitonin or sodium etidronate is added.
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PMID:The role of mithramycin in the management of Paget's disease. 622 Jan 92

Multiple forms of treatment are used for osteoporosis, Paget's disease of the bone, and osteogenesis imperfecta. Because of the effect of fluoride (F) on bone, these bone conditions may benefit from F therapy. In the present study, the metabolic effects of two dose levels of F (20 and 45 mg, given as sodium fluoride) were studied on calcium (Ca) and F metabolism in patients with osteoporosis, whereas the effect of the 45-mg dose was studied in patients with Paget's disease. In patients with osteoporosis, the retention of F increased with increasing F intake, indicating F deposition in bone. However, only the 45-mg dose decreased urinary Ca excretion. F did not decrease fecal Ca excretion, indicating that the intestinal absorption of Ca did not improve during F therapy. This was confirmed in 47Ca absorption studies. The duration of F therapy was 3 months, utilizing the 45-mg dose. Clinically, the patients experienced relief of bone pain, and the onset of this change coincided with the decrease in urinary Ca. The 3-month course of treatment was sufficient for alleviation of clinical symptoms for many months and even years. In patients with Paget's disease, F supplements decreased urinary Ca and also resulted in relief of bone pain. F therapy for osteogenesis imperfecta resulted in decreased fracture incidence.
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PMID:Fluoride therapy in metabolic bone disease. 646 56

An appendicular skeletal response to sodium fluoride (NaF) was detected by total skeletal scintigrams. Twelve postmenopausal osteoporotic women were treated with NaF (88 mg/day) and calcium (1500 mg/day). Total skeletal scintigrams were obtained before and during treatment. Within 4 to 21 mo (mean: 8.3), all 12 patients showed new areas of increased uptake corresponding to metaphyseal regions and short bones of the appendicular skeleton. The number of peripheral bones involved in each subject ranged from four to 12. The most frequently involved sites (11 of 12 patients) were the right distal femur and proximal tibia. Nine patients showed an increase in serum alkaline phosphatase activity, which was attributed to an increase in the skeletal isoenzyme. Seven of 12 patients developed bone pain in one or more of the regions of increased uptake. This study establishes that the skeletal scintigram is a sensitive index of the peripheral skeletal response to NaF.
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PMID:Skeletal scintigraphic changes in osteoporosis treated with sodium fluoride: concise communication. 672 42

A 42-year-old female presented with progressive proximal muscle weakness, generalized hyperreflexia, marked bone pain, severe lumbago and knee arthralgia. Electromyographic study showed short-duration (5-10 msec), variable amplitude (200-2500 microV) polyphasic potentials. A muscle biopsy specimen revealed non-specific type II fiber atrophy. After a comprehensive laboratory work-up, adult Fanconi syndrome was diagnosed. The patient's symptoms, including bone pain and proximal muscle weakness, were relieved after a six-week supplement of tricalcium phosphate, vitamin D3 and sodium bicarbonate. The hyperreflexia also became less brisk.
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PMID:Adult Fanconi syndrome with proximal muscle weakness and hypophosphatemic osteomalacia: report of a case. 785 57


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