Paget’s disease of the bone occurs when the normal processes of bone breakdown and rebuilding are performing abnormally. As a result, the bones become too large and weak as the most optimal structure of bone is not being maintained. While this disease may affect any bone in the body, it often affects the bones of the pelvis and legs, but the skull, lower spine, and sacrum (tail bone) may also be affected. It is estimated that about one million people in the United States have this condition, which is usually seen in older people of Northern European decent, with it being more common in men than women.
Paget’s disease is rarely considered life-threatening in itself, but it can lead to fractures and other problems if not properly taken care of. In the rare case, Paget’s disease can transform into a life-threatening, cancerous bone disease.
The exact cause of Paget’s disease of bone is currently unknown, but is suspected to be a combination of environmental and genetic factors. Scientists have linked several genes to the disease, but no definitive origin has been identified. Some believe that it may be due to a viral infection of the bone, but this theory has not been proven.
Nevertheless, several risk factors have been identified that can increase the risk of developing Paget’s disease of bone, including:
Paget’s disease often develops slowly, making it more manageable that other bone-related diseases. But this doesn’t mean that it is free of complications. The following are possible complications that Paget’s disease patients may experience:
Fractures and deformities: Due to the bone not rebuilding efficiently, the bones break more easily. Bones may start to bow, assuming a misshapen appearance and affecting the ability to walk. Extra blood vessels in these malformed bones may also develop, leading to excessive bleeding during repair surgeries.
Osteoarthritis: Increased stress on bones may lead to increased pressure on various joints, leading to osteoarthritis.
Heart failure: Advanced disease may force the heart to work harder than normal in order to pump blood to the affect areas of the body. This is exceptionally prevalent in those with pre-existing heart disease.
Bone cancer: A very rare complication of Paget’s disease, occurring in less than one percent of people.
Fortunately, most people with Paget’s disease of bone have no symptoms, but the most common presenting symptom is bone pain. This is because the bone is in a constant state of remodelling, generating new bone faster than normal. This leads to bone that is softer and weaker than normal bone, along with the complications previously mentioned.
Pain location is often dependent on the site of most bone remodeling. This means if the disease is affecting the bones in the pelvis or the spine more often, the pain will be focused in those areas. The following are various symptoms that can be associated with Paget’s disease:
Paget’s disease will first be suspected by your doctor on physical examination, as they may see some bone deformity or misshapen bone. This will then prompt the start of various diagnostic tests, which may include the following:
X-rays: Often the first test done, it will show areas of bone resorption, enlargement, and other deformities that are characteristic of the disease.
Bone scan: Using a radioactive material injected into the body before testing, it allows for the highlighting of affected bones during imaging scans.
Blood test: Looking for elevated levels of alkaline phosphatase, which is a sign of bone breakdown.
Treatment of Paget’s disease is often considered on a per patient basis, as those without symptoms might not need treatment. But if lab testing detects any abnormalities—specifically, elevations in alkaline phosphatase—your doctor will most likely recommend treatment due to the increased risk of disease complications down the line.
Medications commonly used include oral bisphosphonates, which are also commonly used in osteoporosis treatment. This medication is typically well tolerated, but may irritate the gastrointestinal tract. Some examples include Alendronate (Fosamax) and Ibandronate (Boniva).
In rare cases of advanced disease, surgery may be required. Surgery is often good to accomplish the following:
While Paget’s disease can be a debilitating affliction, there are things one can do on their own to help relieve symptoms, and possibly even reverse symptoms. It is always important to manage severe conditions with the advice of a medical professional. The following are things you can start doing today:
Get more sunlight: Getting your daily dose of sunlight not only feels great but actually increases the synthesis of vitamin D in the body. Vitamin D is a vital component needed for the absorption of calcium in the intestinal tract. This calcium is then used to help strengthen the bones.
Exercise: Performing light exercise can help keep the muscle and joints in the body strong and healthy, efficiently decreasing the likelihood of Paget’s disease progression. Keeping the body active will also help circumvent associated conditions that people with Paget’s disease often develop, such as osteoporosis and arthritis
Avoid high-impact activity: Do not perform any high impact activity if you have been diagnosed with Paget’s disease of bone as you are at an increased risk for fractures. It is in your best interest to avoid tripping or falling by holding on to handrails and possibly installing them around your house. If you do happen to break a bone, the chances are high that they will heal misshaped.
Lose weight: Being overweight can put unnecessary strain on the bones and joints of the body. This may lead to necessary fractures and bone pain. Losing excess pounds makes it easier to move around, helping those with Paget’s disease manage the condition more adequately.