Paget's disease is the second most common type of bone disease after osteoporosis. It is a disorder of the bone remodeling process, in which the body absorbs old bone and forms abnormal new bone.
Abnormal bone can result from errors in the bone remodeling process.
The body of a person with Paget's disease might generate new bone in incorrect locations or remove old bone from its intended areas.
This process can lead to weakness in the bones, bone pain, arthritis, deformities, and fractures. Many people with Paget's disease do not realize that they have it, as symptoms are often either mild or undetectable.
If a person with Paget's disease fractures a bone, it may take a long time to heal because of faults in the bone renewal process.
In this article, we explore the symptoms, causes, and treatments for Paget's disease, including possible options for surgery.
Many people are not aware that they have Paget's disease because they do not experience symptoms.
They might also mistake any symptoms for other bone disorders, such as arthritis.
The most common symptoms that occur relate to bone or joint pain. Other symptoms include swelling of joints, tenderness, or redness of the skin that covers the areas affected by Paget's disease.
Some people only become aware of their presentation of Paget's disease after experiencing a fracture in a weakened bone.
Paget's disease most commonly occurs in the following bones:
- the pelvis
- the spine
- the skull
- the femur, or thighbone
- the tibia, or shin bone.
Many major nerves in the body run through or alongside the bones, so abnormal bone growth might cause a bone to compress, pinch, or damage a nerve, triggering pain.
While the outlook for people with Paget's disease is generally good, it might lead to other health problems, including:
- hearing loss
- heart disease
- nervous system issues
- Paget's sarcoma, a type of cancer that occurs in 1 percent of people with Paget's disease
- loose teeth
- vision problems
To connection is clear between Paget's disease of the bone and osteoporosis, despite several medications a doctor might prescribe to treat both and a tendency to weaken bones.
Researchers are yet to definitively establish the cause of Paget's disease.
Paget's disease appears to run in families. According to the American College of Rheumatology, more than one family member has the disorder in 30 percent of cases.
Another suggestion is that the disorder possibly occurs due to infection by the measles virus during childhood. Recent studies put forward that measles might alter the mechanism of bone formation, leading to Paget's disease.
However, researchers have not yet uncovered a clear connection between the virus and Paget's disease.
Evidence suggests that the number of people with Paget's disease has been decreasing over the last 25 years. Some scientists have linked the increase in vaccination in many countries and the resulting drop in the number of people with measles to falling rates of Paget's disease.
How common is Paget's disease?
Around 1 million people in the United States have Paget's disease.
Paget's disease tends to occur in older adults as well as people from Northern Europe. The disorder occurs in three men to every two women with Paget's disease.
A doctor normally first identifies the possibility of Paget's disease using physical examination, which may demonstrate abnormalities of the skeletal shape or bone deformities.
They will then use bone scans and laboratory studies to determine the extent of the condition.
An alkaline phosphatase blood test can indicate Paget's disease. People with the disorder have an excess of alkaline phosphatase, an enzyme, in the blood. However, many other diseases or conditions might be the cause of elevated alkaline phosphatase levels.
Bone scans can reveal abnormalities of bone remodeling, including areas of increased and decreased bone deposition.
The doctor should then perform an x-ray on the bones with the disease to confirm the diagnosis.
Treatment can control Paget's disease and reduce the impact of symptoms, but no full cure is available.
Not all people with Paget's disease will need treatment, but if there are symptoms, or if tests show that treatment is necessary, the first line of treatment will normally be bisphosphonates. The might also prescribe vitamin D and calcium as supplements.
Bisphosphonates are medications that help reduce the breakdown of disordered bone. People receiving bisphosphonates also need to maintain adequate levels of vitamin D and calcium.
The Office of Dietary Supplements (ODS) recommends that people should consume 1,200 miligrams (mg) of calcium and at least 600 International Units (IU) of vitamin D a day between the ages of 51 and 70 years.
People older than 70 years of age should increase vitamin D intake to 800 IU a day.
Doctors also recommend increased exposure to sunlight, as this improves the body's ability to make vitamin D.
Take oral bisphosphonates and calcium supplements at least 2 hours apart, as calcium can reduce the absorption of bisphosphonate.
Bisphosphonates and calcium can protect the weaker parts of bone that cause deformity and are at high risk of fracture.
A person with Paget's disease who has previously experienced kidney stones should discuss increasing calcium and vitamin D intake with their doctor.
Surgery may be necessary if Paget's disease leads to a significant bone deformity or a break in the bone.
Fractures are most common in the thighbone and shin bone.
Treatment of these fractures usually involves an intramedullary rod. An orthopedic surgeon inserts this through the marrow cavity in the center of the bone.
Another common surgery in people with Paget's disease is osteotomy. In this procedure, the surgeon removes a wedge of bone to correct a poorly aligned bone. An osteotomy is often necessary when the bones of the legs become misshapen in the later stages of the disease.
The outlook with Paget's disease is generally good, especially if people receive treatment before major bone changes occur.
Paget's Disease is unavoidable for most people with the disorder, but exercise can help to maintain skeletal health, avoid weight gain to relieve pressure on the joints and bones, and maintain joint mobility.
People with the disease should talk to their physician before starting any exercise program, as placing extra stress on bones affected by Paget's disease can lead to injury.
Paget's disease of the bone is a disorder of the process through which the body absorbs and regenerates bone.
It can lead to deformities and weakness that increase the risk of injury and fracture. However, Paget's disease often causes mild symptoms or none at all. Many people with the disorder will not be aware they have it.
While researchers are still exploring the causes of Paget's disease, some believe that it has links to the measles virus, as scientists have found traces of the disease in bone affected by Paget's disease. The disorder has also become less common as the rate of measles has also declined.
Treatment includes oral bisphosphonates and supplements of vitamin D and calcium. A surgical procedure called an osteotomy may be necessary if bones become especially deformed or fractures occur.
The outlook for Paget's disease of the bone is good if a person receives treatment before the development of deformities or weaknesses. However, no full cure is available for the disorder.