About Paget's Disease of the Bone

Paget's disease of the bone is a disorder that alters the way an individual's bone breaks down and reforms. When this process is functioning normally, old bone matter metabolizes in sort of a recycling action. In someone with Paget's disease, the timing mechanism on this function is not working normally and bones become weak and malformed.

This disease is more commonly found in men and in older people, who can mistake its symptoms for normal signs of aging. It usually strikes in the pelvis, legs, spine and skull.

The cause of Paget's disease of the bone is still unknown. However, scientists have been able to find genes linked to the disorder, and heredity seems to play a part in higher risk for some persons. Some believe a dormant viral infection in the bone may become active later and contribute to the disease.

Symptoms

Symptoms of Paget's disease of the bone can be subtle and increase gradually. They can include weakness or tingling (from nerve root compression), pain in joints and bones, easily broken bones, or some deformities such as bowed legs. Headache and hearing loss may also occur, as the disease can lead to an overgrowth of skull bone.

Diagnosis

Blood and urine tests are usually required to definitively diagnose Paget's disease of the bone. The patient may have elevated hydroxyproline in the urine and increased alkaline phosphatase in their blood.

X-ray and bone scan imaging will show abnormalities and deformities in affected bones and joints. In individuals who have not yet experienced symptoms, an x-ray done for another purpose is sometimes the way Paget's disease is first recognized.

Treatment
When Paget's disease of the bone threatens to cause complications, particularly in the spin or skull, it requires treatment. Most of the time, the same medications that treat osteoporosis are used to treat Paget's disease of the bone. These include risedronate, pamidronate, alendronate, ibandronate and zoledronic acid. Some of these are injectable and some are oral medications. In cases where the chosen drugs cause too many gastrointestinal side effects, calcitonin, a natural hormone which aids in bone metabolism, may be prescribed. Calcitonin is self-injectable.

In some extreme cases, surgery may be required to reduce nerve pressure, replace severely deformed joints, put bones back in their proper alignment and aid in healing fractures. Surgery for Paget's disease of the bone carries a high risk of blood loss, since the disease manufactures more blood vessels in the affected bones.

A careful diet and exercise plan are crucial in patients with Paget's disease of the bone. The patient needs a steady intake of vitamin D and calcium to increase bone strength. Regular, low impact exercise is best, in order to reduce the chance of bone fracture or joint displacement. A physical therapist or your doctor can assist in providing a good exercise plan for the individual's needs.

It's important to avoid falls when a person has Paget's disease of the bone due to the increased risk of fracture. In some cases, a walker or cane should be used for stability. Obstacles should be cleared and area rugs should be removed. Hand rails and nonskid mats in the bathroom are highly recommended.

As long as Paget's disease is properly diagnosed and treated, patients can lead a somewhat normal life. Rarely, there are complications such as a type of sarcoma (bone cancer), kidney stones, or heart disease. However, these usually occur in persons with other contributing factors and are uncommon.

It is hoped that with ongoing research, the exact causes of Paget's disease of the bone can be identified and prevention techniques developed.

Sources:

MayoClinic.org

Nlm.nih.gov/medlineplus/pagetsdiseaseofbone.html