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This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.
A 69-year-old man reports increasing pain in the right leg. Physical examination reveals warmth and anterolateral bowing of the right shin. The serum alkaline phosphatase level is 260 U per liter (normal, 38 to 126 U per liter). A skeletal scintigraphic scan reveals enhanced uptake in only the deformed tibia, where a radiograph shows changes indicative of Paget's disease. His sister, whose
The Clinical Problem
Strategies and Evidence
Evaluation
Supportive Therapy
Pharmacologic Therapy
Bisphosphonates
Salmon Calcitonin
Assessing Pharmacologic Treatment
Areas of Uncertainty
Guidelines
Conclusions and Recommendations
Source Information
From the Division of Bone and Mineral Diseases, Washington University School of Medicine at BarnesJewish Hospital, and the Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children both in St. Louis.
Address reprint requests to Dr. Whyte at Shriners Hospitals for Children, 2001 S. Lindbergh Blvd., St. Louis, MO 63131, or at mwhyte@shrinenet.org.
This article has been cited by other articles:
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