Paget disease of bone presenting with pain is initially managed with which of the following?

• A. Bisphosphonates and analgesia
• B. Radiation therapy
• C. Observation only
• D. Surgical fixation

Answer: (A)

The central idea is that Paget disease with pain is best treated first by slowing the abnormal bone turnover and controlling pain. A bisphosphonate is the treatment of choice because it inhibits osteoclast-mediated bone resorption, reduces the high bone turnover characteristic of Paget disease, and often relieves pain while helping normalize bone remodeling. Pairing this with analgesia addresses the immediate symptom of pain and makes the treatment tolerable as the disease activity declines.

Radiation therapy is generally reserved for focal, refractory pain or lesions when medical therapy isn’t sufficient, not as first-line treatment. Observation alone won’t address the active disease and its pain. Surgical fixation is typically considered for fractures or severe deformities after disease control or in cases where mechanical stabilization is required, not as initial management for symptomatic disease.