Pamidronate disodium, a second generation bisphosphonate, has been found to be safe as well as effective in the treatment of Paget's disease of bone.1 It is licensed in the UK and many other countries for the intravenous treatment of Paget's disease. Most units using pamidronate have found the occurrence of flu-like symptoms, fever, and myalgia in 20-30% of patients after the first pamidronate infusion.2 It therefore became our practice that patients received an initial 30 mg "test dose" of pamidronate before receiving a series of fortnightly infusions of 60 mg and this practice is now recommended by the manufacturers. This protocol however increases the number of infusions in a course of pamidronate treatment and therefore the cost and would only be justified if the adverse reactions were therefore minimised. We have therefore conducted a double blind placebo controlled trial to evaluate the need for this initial low dose "test" dose in patients.