What class of drugs is used as first-line treatment for Paget's disease?

• A. Calcitonin
• B. NSAIDs
• C. Bisphosphonates
• D. Corticosteroids

Answer: (C)

Treating Paget's disease centers on suppressing the abnormal bone remodeling by reducing osteoclast activity. The first-line drug class for this is bisphosphonates. These medications bind to bone surfaces and inhibit osteoclast-mediated resorption, with nitrogen-containing bisphosphonates (like alendronate, risedronate, pamidronate, and zoledronic acid) blocking a key pathway inside osteoclasts that leads to decreased activity and cell death. This strong suppression lowers bone turnover, often relieves bone pain, and can normalize the elevated alkaline phosphatase seen in Paget’s disease.

Because of their disease-modifying effect, bisphosphonates are preferred over other options. Calcitonin is older and less potent in controlling the disease; NSAIDs help with pain but do not alter the underlying bone remodeling; corticosteroids are not used as first-line therapy for Paget’s.