2 DEFINITION Paget's disease of bone Paget's disease of bone is a condition that affects the way your bone breaks down and rebuilds (metabolizesThe rate at which old bone is broken down and new bone is formed becomes distorted. Over time, the affected bones may become fragile and misshapen.
3 RIGHT: An X-ray of an upper arm bone (humerus) shows the abnormal growth LEFT: The same person's other arm with a normal humerus is shown
4 SYMPTOMS Most people who have Paget's disease experience no symptoms. The most common complaint is bone pain.The disease may affect only one or two areas of your body, be widespread.Your signs and symptoms will depend on the part of your body that's affected, including:Pelvis. Can cause hip pain.Skull. An overgrowth of bone in the skull can cause hearing loss or headaches.Spine. If your spine is affected, nerve roots can become compressed. This can cause pain, tingling and numbness in an arm or leg.Leg. As the bones weaken, they may bend — causing you to become bow-legged. Enlarged and misshapen bones in your legs can put extra stress on nearby joints, which may cause wear-and-tear arthritis in your knee or hip.When to see a doctor Talk to your doctor if you have:Pain in your bones and jointsTingling and weaknessBone deformities
5 CAUSESEarly in the disease, old bone starts breaking down faster than new bone can be built.Over time, your body responds by generating new bone at a faster than normal rate.This rapid remodeling produces bone that are softer and weaker than normal bone, which can lead to bone pain, deformities and fractures.Scientists have discovered several genes that appear to be linked to the disorder.Some scientists believe Paget's is related to a viral infection in your bone cells that may be present for many years before problems appear.* Hereditary factors seem to influence whether you're at risk for the disease.
6 RISK FACTORSAge - People older than 40 are the most likely to develop Paget's disease of bone.Gender - Men are more commonly affected than are women.National Origin - Paget's disease of bone is more common in people of Anglo-Saxon descent.Family History - If you have a close relative who has Paget's disease of bone, you are much more likely to develop the condition yourself.
7 COMPLICATIONSPaget's disease of bone progresses slowly. The disease can be managed effectively in nearly all people. Possible complications include:Fractures. Bones affected by Paget's disease are large and dense, but also weak and brittle. This makes them more prone to fractures. More blood vessels are created in these deformed bones, so they bleed more during repair surgeries.Osteoarthritis. Misshapen bones can increase the amount of stress on nearby joints, which can cause osteoarthritis.Heart failure. Unusually extensive Paget's disease may force your heart to work harder to pump blood to the affected areas of your body. In people with pre-existing heart disease, this increased workload can lead to heart failure.Bone cancer. Bone cancer occurs in less than 1 percent of people with Paget's disease.
8 TEST & DIAGNOSISA variety of tests can confirm a diagnosis of Paget's disease of bone. Your doctor also may order these types of tests during treatment, to see if the medications are working.Imaging testsX-rays - The first indication of Paget's disease is often abnormalities found on X-rays done for other reasons. X-ray images of your bones can show areas of bone reabsorption, enlargement of the bone and deformities that are characteristic of Paget's disease, such as bowing of your long bones.Bone scan - In a bone scan, radioactive material is injected into your body. This material travels to the spots on your bones most affected by Paget's disease, so they light up on the scan images.Lab tests People who have Paget's disease of bone usually have elevated levels of alkaline phosphatase in their blood. They may also have increased amounts of hydroxyproline in their urine, particularly if the disease affects more than one
9 TREAMENT If you don't have symptoms, you may not need treatment. However, if the disease is active and is affecting high-risk sites in your body your doctor may recommend treatment to prevent complications, whether or not you have symptoms.Medications Osteoporosis drugs (bisphosphonates) are the most common treatment for Paget's disease of bone. Some of these drugs are given as oral medications, while others are given by injection. Oral osteoporosis drugs are generally well tolerated, but may irritate your gastrointestinal tract.
10 SURGERY In rare cases, you may require surgery to: Help fractures healReplace joints damaged by severe arthritisRealign deformed bonesReduce pressure on nervesPaget's disease often causes the body to produce an excessive number of blood vessels in the affected bones.This increases the risk of serious blood loss during an operation.
11 DIFFERENT LIFESTYLEPrevent falls. Paget's disease puts you at high risk of bone fractures. Ask your doctor for advice on preventing falls. He or she may recommend that you use a cane or a walker. Take measures to fall-proof your home. Remove slippery floor coverings, use nonskid mats in your bathtub or shower, tuck away cords, and install handrails on stairways and grab bars in your bathroom.Eat well. Be sure your diet includes adequate levels of calcium and vitamin D, which facilitates the absorption of calcium. This is especially important if you're being treated with osteoporosis drugs. Review your diet with your doctor and ask if you should begin taking vitamin and calcium supplements.Exercise regularly. Exercising on a regular basis is essential for maintaining joint mobility and bone strength. Talk to your doctor before beginning an exercise program to determine the right type, duration and intensity of exercise for you. Some activities may place too much stress on your affected bones.