In addition, some guidelines (1), recommend treatment to Prevent or retard progression of complications (eg, hearing loss, deformity, osteoarthritis, paraparesis or paraplegia related to vertebral Paget disease, or other neurologic deficits), particularly in a poor surgical candidate Prevent or minimize bleeding if orthopedic surgery is planned at a site with pagetic involvement Suppress excessive osteoclast activity when serum alkaline phosphatase (of bony origin) is > 2 times the normal level, even in the absence of symptoms Although disease progression can be retarded by medications, existing deficits (eg, deformity, osteoarthritis, hearing loss, neural impingement) are not reversed.