Find out about this condition that can make bones fragile and misshapen, along with the osteoporosis drugs that can treat it.
Paget's (PAJ-its) disease of bone interferes with your body's normal recycling process, in which new bone tissue gradually replaces old bone tissue. Over time, bones can become fragile and misshapen. The pelvis, skull, spine and legs are most commonly affected.
The risk of Paget's disease of bone increases with age and if family members have the disorder. However, for reasons unknown to doctors, the disease has become less common over the past several years and is less severe when it does develop. Complications can include broken bones, hearing loss and pinched nerves in your spine.
Bisphosphonates — the medications used to strengthen bones weakened by osteoporosis — are the mainstay of treatment. Surgery may be necessary if complications occur.
Most people who have Paget's disease of bone have no symptoms. When symptoms occur, the most common complaint is bone pain.
Because this disease causes your body to generate new bone faster than normal, the rapid remodeling produces bone that's less organized and weaker than normal bone, which can lead to bone pain, deformities and fractures.
The disease might affect only one or two areas of your body or might be widespread. Your signs and symptoms, if any, will depend on the affected part of your body.
Talk to your doctor if you have:
The cause of Paget's disease of bone is unknown. Scientists suspect a combination of environmental and genetic factors contribute to the disease. Several genes appear to be linked to getting the disease.
Some scientists believe Paget's disease of bone is related to a viral infection in your bone cells, but this theory is controversial.
Factors that can increase your risk of Paget's disease of bone include:
In most cases, Paget's disease of bone progresses slowly. The disease can be managed effectively in nearly all people. Possible complications include:
During the physical exam, your doctor will examine areas of your body that are causing you pain. He or she may also order X-rays and blood tests that can help confirm the diagnosis of Paget's disease of bone.
Bone changes can be revealed by:
People who have Paget's disease of bone usually have elevated levels of alkaline phosphatase in their blood, which can be revealed by a blood test.
If you don't have symptoms, you might not need treatment. However, if the disease is active — indicated by an elevated alkaline phosphatase level — and is affecting high-risk sites in your body, such as your skull or spine, your doctor might recommend treatment to prevent complications, even if you don't have symptoms.
Osteoporosis drugs (bisphosphonates) are the most common treatment for Paget's disease of bone. Bisphosphonates are typically given by injection into a vein, but they can also be taken by mouth. When taken orally, bisphosphonates are generally well tolerated but can irritate the stomach.
Bisphosphonates that are given intravenously include:
Oral bisphosphonates include:
Rarely, bisphosphonate therapy has been linked to severe muscle, joint or bone pain, which might not resolve when the medication is discontinued. Bisphosphonates can also increase the risk of a rare condition in which a section of jawbone dies and deteriorates, usually associated with active dental disease or oral surgery.
If you can't tolerate bisphosphonates, your doctor might prescribe calcitonin (Miacalcin), a naturally occurring hormone involved in calcium regulation and bone metabolism. Calcitonin is a drug that you administer to yourself by injection or nasal spray. Side effects may include nausea, facial flushing and irritation at the injection site.
In rare cases, surgery might be required to:
Paget's disease of bone often causes the body to produce too many blood vessels in the affected bones, increasing the risk of serious blood loss during an operation.
If you're scheduled for surgery that involves bones affected by Paget's disease of bone, your doctor might prescribe medications to reduce the activity of the disease, which may help reduce blood loss during surgery.
To reduce your risk of complications associated with Paget's disease of bone, try these tips:
Most people with Paget's disease of bone don't have any symptoms and are diagnosed when an X-ray or blood test taken for another reason reveals signs of Paget's disease of bone. In some cases, you may be referred to a doctor who specializes in metabolic and hormonal disorders (endocrinologist) or in joint and muscle disorders (rheumatologist).
Here's some information to help you get ready for your appointment.
When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:
Take a family member or friend along, if possible, to help you remember the information you're given.
For Paget's disease of bone, some basic questions to ask your doctor include:
Don't hesitate to ask other questions.
Your doctor is likely to ask you some of the following questions:
February 3rd, 2021