Paget's Disease

Paget's disease, also known as osteitis deformans, occurs when the normal process of bones being broken down and rebuilt goes awry. With Paget's disease, the bone breaks down more quickly. When it is rebuilt, it is softer than normal bone.

The disease can affect any bone but usually affects the spine, pelvis, skull, thighbone (femur) and shinbone (tibia). In addition, Paget's disease can lead to other conditions including osteoarthritis, kidney stones and heart disease.

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Symptoms

Signs of Paget's disease include:

  • Soft, porous bones that are weak and easily bend. This can lead to shortening of the body in the affected area.
  • Build-up of too much bone. As the bone is quickly replaced with Paget's disease, extra bone is formed, causing bones to get larger, be painful and break easily.
  • An abnormal increase in the blood vessels in the bone affected by Paget's disease. This may cause the area to feel warmer than usual.

Causes and Risk Factors

It is not yet known what exactly causes Paget's disease. A slow-acting virus may be involved, although it hasn't been identified yet. There may be a genetic element. Some studies have shown that up to 30% of those with Paget's disease have family members who also have the condition. The disease is more common in areas where many people are of Anglo-Saxon descent.

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Diagnosis

Often, Paget's disease can be diagnosed after your doctor has taken your medical history and done a physical exam. An X-ray of the affected bones, bone scans and blood and urine tests can confirm the diagnosis and show what parts of the bone are affected. Paget's disease is sometimes discovered during the course of a physical exam for another problem. There may not be any symptoms at the time, but routine tests may indicate that Paget's disease is present.

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Treatments

The doctors at the Cedars-Sinai Orthopedic Center specialize in diagnosing Paget's disease. Having a rheumatologist or endocrinologist (or both) on your healthcare team can also be helpful. A rheumatologist is a doctor trained in diagnosing and treating problems with the joints, muscles and other parts of the body. An endocrinologist is trained in diagnosing and treating metabolic and hormonal disorders. These disorders affect how fast body systems work and grow.

There is no cure for Paget's disease yet. Treatment can, however, slow the rate of bone loss, build up new bone and lessen pain. Treatment of Pagets disease includes:

Drug Therapy

  • Bisphosphonates including Didronel, Fosamax and Actonel help the body produce normal bone.
  • Calcitonin helps relieve pain, slow bone loss and help growth.
  • Pain relievers such as acetaminophen (Tylenol, Panadol, Exdol) or pain-relieving anti-inflammatory drugs such as aspirin can help. Anti-inflammatory drugs also help reduce swelling and stiffness.
  • Calcium supplements (1,000 to 1,500 mg of calcium a day)
  • Vitamin D supplements. Persons with Paget's disease should get at least 400 units of vitamin D a day. This helps the bone absorb calcium and grow. People with Paget's disease often have too little vitamin D in their bodies.

Exercise

  • Makes the muscles around a joint stronger. This protects it and preserves the range of motion.
  • Helps maintain a healthy weight. That puts less strain on the body and bones.
  • A physical therapist can show you the best types of exercise to safely do when you have Paget's disease.

Heat / Cold

  • Applying heat (such as taking a hot shower) helps relax aching muscles, reducing the pain and stiffness.
  • Applying cold (such as an ice pack) reduces the pain and swelling.

Preventive Care

  • After doing heavy or repetitive work, stop and rest. Switch regularly from heavy work to slower paced, easier tasks. The different tasks use different muscles and joints.
  • Use your back, arms and legs in safe ways to avoid putting stress on joints. For example, carry a heavy load close to your body or use devices such as a cart to carry your grocery bags.

Surgery

  • People with severe Paget's disease may need surgery, especially if a joint is badly damaged. Surgery can be done to repair or rebuild parts of the bone, fix fractures or After surgery, a person with Paget's disease is able to move better and with less pain.