What Is Paget's Disease?
Paget’s disease is a slowly progressive bone disorder, most commonly affecting the spine, hip, skull, thigh, shin, and upper arm, although almost any bone may be involved. Bone is continuously broken down and restored. In the initial stages of Paget’s disease, too much bone is broken down and, to compensate, new bone is formed at an increased rate. Often, however, the new bone cells are laid down in a disordered pattern, making the bone weak and prone to fractures. In addition, overgrowth of new bone results in deformities in affected areas.
The disease is most common in those over age 40, affecting up to 3 percent of the population in some parts of the world. Most cases are mild and tend to progress slowly. Advanced cases, however, may cause pain, deformity, incapacitation, hearing loss, or heart failure. Malignant bone cancer (sarcoma), the most serious complication, occurs in less than 1 percent of cases.
What Causes Paget's Disease?>
The cause of Paget’s disease is unknown, although viral infection appears to play a role. Indeed, the disease has been reported to occur within families but is not transmitted from one generation to another. This finding is consistent with an infectious disorder.
Symptoms of Paget's Disease
- Most cases go unnoticed and are discovered incidentally when x-rays or blood tests are taken for another reason. In more severe cases symptoms may occur and are highly variable.
- Bone pain (usually persistent and sometimes severe)
- Neck or back pain (especially the lower back), which may radiate to the buttocks or legs
- Pain or stiffness in the joints (especially the hips, knees, or shoulders), resembling osteoarthritis
- Warmth in the skin overlying affected bones
- Unexplained bone fractures
- Bone swelling or deformities, including bowed legs, skull enlargement around the eyes and forehead, barrel-shaped chest, or bent spine causing reduced height
- Hearing loss, ringing in the ears
- Headache, dizziness
- Pressure on nerves
Paget's Disease Prevention
- There are no specific preventive measures.
- For those with Paget’s disease, regular checkups are advised to screen for early bone cancer or to detect hearing loss.
Paget's Disease Diagnosis
- X-rays or bone scans are taken.
- Blood or urine tests may point to the diagnosis.
- Alkaline phosphatase blood test may suggest Paget’s disease.
- A bone biopsy may be required.
How to Treat Paget's Disease
- Most patients never develop symptoms and so do not require treatment.
- Over-the-counter (OTC) analgesics (aspirin, ibuprofen, acetaminophen) may be used to reduce pain and inflammation.
- Prescription anti-inflammatory drugs may be needed when OTC products prove to be inadequate.
- Drugs (such as calcitonin, alendronate, risedronate, and pamidronate) that correct the abnormally rapid bone metabolism may be prescribed. These medications may completely halt the progression of the disease in some patients, but the damage that has already occurred is usually irreversible.
- Orthopedic surgery may be indicated. For example, if bone deformities lead to difficulty in walking, hip replacement or reshaping the leg bones may be performed to improve gait.
- To maintain skeletal health, strive to avoid weight gain and maintain joint mobility by eating healthily and exercising regularly.
See your doctor if symptoms of Paget’s disease develop.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media