A single bone lesion in a man with prostate cancer: a case report of Paget’s disease of bone

Federica Bellone, Nunziata Morabito, Annamaria Pugliese, Gabriella Martino, Antonino Catalano


Paget's disease of bone (PDB) is the second most common type of bone disease after osteoporosis. It should be considered in the differential diagnosis of bone lesions in elderly men with prostate cancer and single bone involvement, especially if increased serum levels of alkaline phosphatase coexist. We present the clinical case of a patient with moderate chronic renal failure who was diagnosed with prostate cancer, later treated surgically. He presented a bone lesion at the left hemipelvis for which the suspected PDB was confirmed by biopsy. The aminobisphosphonate neridronate has been administered with a cumulative dose of 200 mg, as a medical treatment of PDB. Due to the potential nephrotoxicity of the aminobisphosphonates such as neridronate in patient with reduced glomerular filtration rate (GFR), an alternative treatment of the PDB with denosumab, a fully human monoclonal antibody that binds RANKL, has been discussed and proposed, in case of relapse of PDB and further deterioration of GFR


Paget’s disease; prostate cancer; renal failure; neridronate; denosumab

Full Text:



Merlotti, D., Rendina, D., Gennari, L., Mossetti, G., Gianfrancesco, F., Martini, G., De Filippo, G., Avanzati, A., Franci, B., Campagna, M.S., Strazzullo, P., Nuti, R. (2011) Comparison of intravenous and intramuscularneridronateregimens for the treatment of Pagetdisease of bone. J Bone Miner Res 26(3):512-51

Gennari, L., Di Stefano, M., Merlotti, D., Giordano, N., Martini, G., Tamone, C., Zatteri, R., De Lucchi, R., Baldi, C., Vattimo, A., Capoccia, S., Burroni, L., Geraci, S., De Paola, V., Calabrò, A., Avanzati, A., Isaia, G., Nuti, R. (2005)Prevalence of Paget'sdisease of bone in Italy. J Bone Miner Res 20(10):1845-1850

Morabito, N., Gaudio, A., Lasco, A., Catalano, A., Atteritano, M., Trifiletti, A., Anastasi, G., Melloni, D., Frisina, N. (2004)Neridronate prevents bone loss in patients receiving and rogende privation therapy for prostate cancer. J Bone Miner Res 19(11):1766-1770.

Miller, P.D., Eardley, I., Kirby, R.S. (1992) Prostate specific antigen and bone scan correlation in the staging and monitoring of patients with prostatic cancer. Br J Urol70(3):295-298

Metwalli, A.R., Rosner, I.L., Cullen, J., Chen, Y., Brand, T., Brassell, S.A., Lesperance, J., Porter, C., Sterbis, J., McLeod, D.G. (2014) Elevated alkaline phosphatase velocity strongly predicts overall survival and the risk of bone metastases in castrate-resistant prostate cancer. UrolOncol32(6):761-768

Sirikulchayanonta, S., Jaovisidha, S., Kongchareonsombat, W., Sirikulchayanonta, V. (2014) Paget's disease of bone in ethnic Thai presented with urologic symptoms and misleading as metastatic prostate cancer: report of a case with a review of the literature. J Med Assoc Thai 97(6):673-677

Catalano, A., Gaudio, A., Morabito, N., Basile, G., Agostino, R.M., Xourafa, A., Atteritano, M., Morini, E., Natale, G., Lasco A. (2017) Quantitative ultrasound and DXA measurements in aromatase inhibitor-treated breast cancer women receiving denosumab. J Endocrinol Invest 40(8):851-857

Perazella, M.A., Markowitz, G.S. (2008) Bisphosphonate nephrotoxicity. Kidney Int74:1385–1393

Chang, J.T., Green, L., Beitz, J. (2003) Renal failure with the use of zoledronic acid. N Engl J Med 349:1676–1679

Bergner, R., Siegrist, B., Gretz, N., Pohlmeyer-Esch, G., Kränzlin, B. (2015) Nephrotoxicity of ibandronate and zoledronate in Wistar rats with normal renal function and after unilateral nephrectomy. Pharmacol Res 99:16-22

Adami S, Bartolozzi P, Brandi ML, Falchetti A, Filipponi P, Gonnelli S, Bianchi G, Isaia GC, Nuti R; Collegio Reumatologi Ospedalieri Italiani; Società Italiana di Medicina Interna; Società Italiana di Ortopedia e Traumatologia; Società Italiana di Osteoporosi e Malattie del Metabolismo Minerale e Scheletrico; Società Italiana di Reumatologia. (2007) Italian guidelines for the diagnosis and treatment of Paget's disease of bone. Reumatismo 59(2):153-168

Martino, G., Catalano, A., Bellone, F., Sardella, A., Lasco, C., Caprì, T., Langher, V., Caputo, A., Fabio, R.A., Morabito, N. (2018) Vitamin D status is associated with anxiety levels in postmenopausal women evaluated for osteoporosis. Mediterranean Journal of Clinical Psychology 6(1): 1-16

Catalano, A., Morabito, N., Atteritano, M., Basile, G., Cucinotta, D., Lasco, A. (2012) Vitamin D reducesmusculoskeletalpainafterinfusion of zoledronic acid for postmenopausalosteoporosis. Calcif Tissue Int90(4):279-285

Gaudio, A., Lasco, A., Morabito, N., Atteritano, M., Vergara, C., Catalano, A., Fries, W., Trifiletti, A., Frisina, N. (2005) Hepatic osteodystrophy: does the osteoprotegerin/receptor activator of nuclear factor-kB ligand system play a role? J EndocrinolInvest28(8):677-682

Morabito, N., Russo, G.T., Gaudio, A., Lasco, A., Catalano, A., Morini, E., Franchina, F., Maisano, D., La Rosa, M., Plota, M., Crifò, A., Meo, A., Frisina, N. (2007) The "lively" cytokines network in beta-Thalassemia Major-relatedosteoporosis. Bone 40(6):1588-1594

Scott, L.J. (2014) Denosumab: a review of its use in postmenopausal women with osteoporosis. DrugsAging31(7):555-576

Lasco, A., Morabito, N., Basile, G., Atteritano, M., Gaudio, A., Giorgianni, G.M., Morini, E., Faraci, B., Bellone, F., Catalano, A. (2016)Denosumab Inhibition of RANKL and Insulin Resistance in Postmenopausal Women with Osteoporosis. Calcif Tissue Int98(2):123-128

Jamal, S.A., Ljunggren, O., Stehman-Breen, C., Cummings, S.R., McClung, M.R., Goemaere, S., Ebeling, P.R., Franek, E., Yang, Y.C., Egbuna, O.I., Boonen, S., Miller, P.D. (2011) Effects of denosumab on fracture and bone mineral density by level of kidney function. J Bone Miner Res 26:1829-1835

Martini, G., Gennari, L., Merlotti, D., Salvadori, S., Franci, M.B., Campagna, S., Avanzati, A., De Paola, V., Valleggi, F., Nuti, R. (2007) Serum OPG and RANKL levels before and after intravenous bisphosphonate treatment in Paget's disease of bone. Bone 40(2):457-463

Schwarz, P., Rasmussen, A.Q., Kvist, T.M., Andersen, U.B., Jorgensen, N.R. (2012) Paget's disease of the bone after treatment with Denosumab: a case report Bone 50(5):1023-1025

Reid, I.R, Sharma, S., Kalluru, R., Eagleton, C. (2016) Treatment of Paget's Disease of Bone with Denosumab: Case Report and Literature Review. Calcif Tissue Int 99(3):322-325

Polyzos, S.A., Singhellakis, P.N., Naot, D., Adamidou, F., Malandrinou, F., Anastasilakis, A.D., Polymerou, V., Kita M. (2014) Denosumab treatment for juvenile Paget's disease: results from two adult patients with osteoprotegerin deficiency ("Balkan" mutation in the TNFRSF11B gene). J ClinEndocrinolMetab 99(3):703-707

Rea, S.L., Walsh, J.P., Ward, L., Magno, A.L., Ward, B.K., Shaw, B., Layfield, R., Kent, G.N., Xu, J., Ratajczak, T. (2009) Sequestosome 1 mutations in Paget's disease of bone in Australia: prevalence, genotype/phenotype correlation, and a novel non-UBA domain mutation (P364S) associated with increased NF-kappaBsignaling without loss of ubiquitin binding. J Bone Miner Res 24(7):1216-1223

Chang, M.A., Morgado, M., Warren, C.R., Hinton, C.V., Farach-Carson, M.C., Delk, N.A. (2014) p62/SQSTM1 is required for cell survival of apoptosis-resistant bone metastatic prostate cancer cell lines. Prostate 74(2):149-163

Catalano, A., Martino, G., Morabito, N., Scarcella, C., Gaudio, A., Basile, G., Lasco, A. (2017) Pain in Osteoporosis: From Pathophysiology to Therapeutic Approach. Drugs Aging 34(10):755-765

DOI: https://doi.org/10.6092/1828-6550/APMB.106.2.2018.A8


  • There are currently no refbacks.

Copyright (c) 2018 Federica Bellone, Nunziata Morabito, Annamaria Pugliese, Gabriella Martino, Antonino Catalano

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.