Paget's Disease of Bone

As people age, their bones tend to rebuild at a slower rate. In Paget's disease, however, the rebuilding of bones takes place faster. As a result, the rebuilt bone can be softer and larger than it should be. This usually happens in one bone or a few bones in one area (localized). The disease is more common in older people. It can run in families, especially in those with European descent. Men are twice as likely as women to have this disease. Treatment can help most people with Paget's disease.

CAUSES

The cause is not known. It appears to run in families. It is possibly made active by an uncommon virus infection.

SYMPTOMS

Common symptoms include:

  • Bone or joint pain.

  • Swelling of joints.

  • Tenderness or redness over the affected areas.

Occasionally, people do not know they have Paget's disease until they experience a broken bone (fracture) in a weakened area of bone. The most common bones affected by Paget's disease are:

  • Pelvis.

  • Thighbone.

  • Spine.

  • Skull.

  • Shinbone.

Further problems from Paget's disease can include bony deformities, arthritis, and narrowing of the spine (stenosis). Heart disease may occur with severe Paget's disease, because the heart works harder to pump blood to the affected bones. Certain types of Paget's disease have a less than 1% chance of developing bone cancer.

DIAGNOSIS

Diagnosis is most often made by X-rays. However, physical exam and lab studies can help to support the diagnosis. In a person with Paget's disease, lab studies will show an increased level of alkaline phosphatase. This is a by-product of bone development. Painless bone scans can also be done to help determine the number of bones affected.

TREATMENT

The goal of treatment is to relieve bone pain and prevent the disease from progressing. The following treatment options may be given.

Drug therapy

  • Pain medicines. This includes acetaminophen and anti-inflammatory drugs, such as ibuprofen and naproxen.

  • Bisphosphonates. This is a class of drugs used to treat a variety of bone diseases.

  • Calcitonin is a naturally occurring hormone made by the thyroid gland. This medicine may be appropriate for certain patients but is generally less effective than bisphosphonates and is seldom used.

Surgery

  • In a patient with fractures, surgery may allow the bones to heal in better positions.

  • Surgery for arthritis caused by Paget's disease is effective in reducing pain and improving function.

  • In a patient with bone deformity, cutting and realigning the affected bones (osteotomy) may reduce the pain in weight-bearing joints, especially the knees.

HOME CARE INSTRUCTIONS

  • Take medicines as instructed.

  • Discuss intake of vitamin D and calcium supplements with your caregiver.

  • Discuss an exercise program with your caregiver.

SEEK MEDICAL CARE IF:

  • You have increasing pain, or problems occur in spite of treatment.

FOR MORE INFORMATION

The Paget Foundation: www.paget.org

National Institutes of Health Osteoporosis and Related Bone Diseases: www.bones.nih.gov

Arthritis Foundation: www.arthritis.org