Drug Class





40 mg/day for 6 mo;


Slows rate of bone turnover In


may also use etidronate, risedronate

calcium regulator

pagetic lesions; lowers serum alkaline phosphatase; reduces elevated cardiac output by decreasing vascularity of bone, thereby averting high-output cardiac failure


100 IU SC or IM qd initially and then 50 IU SC three times a week

Calcium regulator

Decreases the number and availability of osteoclasts, thereby retarding bone resorption relieves bone pain; helps the remodeling of pagetoid bone into lamellar bone


Focus on reducing pain and immobility, preventing injury, and educating the patient about the disease and treatment regimen. Correlate the patient's pain with her or his activities, and modify schedules as needed. Instruct the patient in the use of relaxation techniques such as guided imagery and music therapy. Evaluate the patient's level of functioning, and encourage the patient to remain as active as possible. Perform range-of-motion exercises to joints, unless contraindi-cated, progressing from passive to active exercise as tolerated. Encourage the patient to perform self-care activities independently.

For patients on extended bedrest, reposition the patient frequently and use a flotation mattress. Prevent pressure ulcers by providing meticulous skin care.

Institute measures to prevent injury. Instruct the patient to move slowly and avoid sudden movements. Keep the environment free of clutter. Encourage the use of ambulation aids, such as walkers or canes, as needed. Carefully plan exercise protocols and activity regimens to minimize fatigue.

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