Paget's Disease of the Bone

Written by Jaime Herndon | Published on July 9, 2012
Medically Reviewed by George Krucik, MD

What Is Paget’s Disease of the Bone?

A typical human skeleton consists of 206 bones. Bones are constantly being broken down and rebuilt. If this process is altered, bones can break down and re-form abnormally and in ways that compromise the integrity of the skeleton.

Paget’s disease of the bone, also called osteitis deformans, is a chronic condition that affects the skeleton. It commonly affects older adults. According to the American Academy of Orthopaedic Surgeons (AAOS), the condition occurs in three to four percent of those over 50 years old (AAOS, 2007).

In this disease, abnormal breakdown of bone occurs with subsequent abnormal bone formation. The new bone that is formed is significantly oversized, weak, and typically deformed.

The condition can affect any part of the skeleton. It may affect only one or two parts of the skeleton, or it may be widespread. The arms, spine, skull, pelvis, and leg bones are commonly affected.

Doctors do not know what causes Paget’s disease of the bone. Genetic and viral factors may play a role, but more research is required. While there are no known preventive measures you can take, a diet that contains adequate amounts of calcium and vitamin D, along with regular exercise, can help promote bone health.

What Are the Symptoms of Paget’s Disease of the Bone?

Many individuals with Paget’s disease of the bone have no symptoms. The condition is typically diagnosed during an X-ray for an unrelated problem. It may also be detected during a routine blood test, if abnormal calcium levels are present.

When symptoms do occur, they may include:

  • bone pain
  • joint stiffness
  • bone fractures
  • deformities of the legs or skull
  • hearing loss
  • nerve compression and sensory problems due to enlarged bones

If Paget’s disease affects multiple bones, calcium levels in the body can become abnormally high due to rapid bone breakdown. This can cause fatigue, loss of appetite, and constipation.

Tests Used to Diagnose Paget’s Disease

If your doctor suspects that you might have Paget’s disease of the bone, he or she may conduct a variety of tests to confirm the diagnosis and see which bones are affected. Tests may include:

  • a bone scan or X-ray imaging test to check for bone deformities
  • a blood test to detect high levels of serum alkaline phosphatase in the blood (Alkaline phosphatase is an indicator of bone turnover, and is usually very high in patients with Paget’s disease.)
  • a blood test to detect abnormally high serum calcium levels

Sometimes a biopsy of the bone is necessary. This can be done using a needle or, more rarely, by making incisions. A needle biopsy may be done in your doctor’s office, but if small incisions need to be made, this will be done in an operating room. The doctor will remove a small section of bone and send it to a laboratory for testing to rule out other illnesses such as cancer.

What Are the Treatment Options for Paget’s Disease?

Depending on the severity of your condition, you may not need any treatment. However, multiple treatments are available for Paget’s disease of the bone, both nonsurgical and surgical. Medical treatments cannot cure the condition, but they can relieve symptoms. Surgical treatments are typically used if complications arise.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help reduce pain. For severe bone pain, bisphosphonates may be used. These drugs block the cells that absorb bone. They can be taken orally or intravenously, depending on the specific drug. Calcitonin is also used to help with bone metabolism.

Assistive Devices

A cane can help with balance and to ease stress on your bones. This may reduce bone pain and lessen your chances of falling and breaking a bone. Braces can also be used to aid in proper alignment of the bones.

Surgery

If a fracture or severe misalignment is present, surgery might be necessary. If the bones are compressing nerves, especially spinal nerves, surgery is done. Healing often takes longer than usual because your bones are weaker than normal.

What Is the Long-Term Outlook for Paget’s Disease?

While treatments can alleviate symptoms, complications can arise from this disease. Some patients may need joint replacement if there is extensive joint damage.

According to doctors at the Liddy Shriver Sarcoma Initiative, approximately one percent of those with Paget’s disease of the bone develop osteosarcoma (LSSI, 2005), a type of bone cancer.

Other possible complications include:

  • heart failure
  • spinal stenosis (narrowing of the spinal column or of the openings where nerves leave the spinal column, causing pressure on nerves that results in pain and/or numbness)
  • multiple fractures
  • physical deformities

Talk with your doctor about possible complications and how they can be treated.

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