A 63-year-old White man presents with bowing deformity of his legs, gait abnormality, and tingling and weakness in his left leg. He is diagnosed with Paget’s disease of bone and asks the NP about his treatment options. Which of the following therapies is considered first line?

Choice A reason: Bisphosphonates are the first-line therapy for Paget’s disease as they inhibit bone resorption, help normalize bone turnover, and alleviate symptoms such as bone pain and deformity. Choice B reason: Calcitonin is less effective than bisphosphonates and is generally reserved for patients who cannot tolerate bisphosphonates. Choice C reason: Vitamin D supplementation may be supportive but is not sufficient as primary therapy for Paget’s disease. Choice D reason: NSAIDs can help relieve bone pain but do not alter disease progression and are considered adjunct therapy rather than first-line treatment.