Paget's disease of bone

► Paget's disease is a focal bone disorder characterised by accelerated remodelling activity. ► Epidemiologic studies suggest that Paget's disease is decreasing in prevalence and severity, but there is an important genetic predisposition. ► All bone turnover markers (except osteocalcin) are increased in patients with active disease; of the newer markers plasma procollagen-1 N-peptide performs best. ► Treatment with potent bisphosphonates such as zoledronate can achieve long-term remission. ► Good suppression of turnover markers early after treatment predicts the duration of remission.