The analgesic effect of pamidronate is not caused by the elevation of beta endorphin level in Paget's disease--a controlled pilot study.

INTRODUCTION: Although an analgesic effect is an essential component of the mode of action of bisphosphonates, its physiological mechanisms are still unclear. Beta-endorphin release plays an important role in the analgesic effect of both calcitonin and raloxifene. As patients with Paget's disease receive large doses of bisphosphonates within relatively short time periods, we examined whether repeated pamidronate infusion therapy would cause measurable change in beta-endorphin levels MATERIALS & METHODS: Visual analog scale (VAS) scores of pain intensity, beta-endorphin levels, and alkaline phosphatase activity of 11 patients with Paget's disease (7 with the mono- and 4 with the polyostotic form) were determined at baseline, as well as after 3 and 6 infusions (on Days 6 and 12 of treatment, respectively). Eleven untreated patients with Paget's disease (7 with the mono- and 4 with the polyostotic form) served as controls. RESULTS: It was established that in the course of pamidronate infusion therapy BE levels remained constant, whereas the values in serum alkaline phosphatase and pain intensity scores were significantly reduced. CONCLUSIONS: Although high-dose pamidronate therapy does mitigate pain substantially (as demonstrated by the reduction of VAS scores), its analgesic action is probably unrelated to the enhancement of beta-endorphin release.

The prevalence of diffuse idiopathic skeletal hyperostosis in a population-based study in Hungary.

Diffuse idiopathic skeletal hyperostosis (DISH) is a skeletal disease characterized by ligamentous ossification of the antero-lateral side of the spine. The prevalence of DISH was studied in a cross-sectional, population-based study of Hungarian men and women, 50 years and over. The study was based on an analysis of the lateral thoracic and lateral lumbar radiographs of 635 persons recruited from a population register in Budapest, Hungary. Radiographs were taken according to standardised protocol and DISH was classified using the Resnick and modified Resnick criteria. The prevalence of hyperostosis according to the modified Resnick criteria was 27.3% in men and 12.8% in women. There was an increase in the prevalence of DISH with increasing age in men, from 10.0% in the 50-54 year age group to 36.6% in those over 75 years, and in women from 1.9% to 25.9% in the same age groups. According to this radiology survey the disease is more frequent and more severe in men than in women throughout life.