Indications for treatment with antiresorptive agents:
(1) symptomatic
(1a) bone or articular pain
(1b) bone deformity
(1c) bone, articular or neurologic complications
(1d) headache with skull involvement
(1e) fissure fractures
(2) asymptomatic disease but location of involvement at high risk for complications
(2a) base of skull (hearing, other neurologic complications)
(2b) spine (spinal cord or nerve compression)
(2c) long bones of lower extremities (fracture or nerve compression)
(2d) about the hip and knee joints (osteoarthritis)
(3) preparation for elective orthopedic surgery for a pagetic site
(4) early onset disease with long life expectancy
(5) hypercalcemia secondary to immobilization
When not to treat:
(1) absence of symptoms in a patient with site of disease associated with little or low risk of complications
(1a) iliac crest
(1b) sacrum
(1c) scapula
(1d) upper limbs
(1e) ribs
(2) advanced age or short life expectancy
