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Paget’s disease of the bone

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Introduction to paget’s disease1,2

Paget’s disease, also known as osteitis deformans is considered as the next most common bone disorder to osteoporosis and is commonly noticed in England, USA, Australia and New Zealand and rarely in Scandinavia, Asia and Africa. Paget’s disease is characterized by excessive bone destruction in certain specific areas of the bone, which is followed by new bone formation. Eventually the normal bone marrow is replaced by another type of tissue that is incapable of performing normal functions of the bone marrow. Paget’s disease is noticed more commonly in individuals above the age of 50 years and affects both men and women. It is rarely noticed in individuals younger than 40 years of age. Although asymptomatic most of the times, Paget’s disease is characterized by bone pain and deformity in the bones.

Signs and Symptoms of paget’s disease3,4   

Paget’s disease is often asymptomatic and is identified incidentally in individuals who are undergoing certain routine tests such as radiography. In others it may result in bone pain, bone deformity or fracture and also lead to other general conditions such heart failure (severe cases), increased concentration of calcium, deafness depending upon the type of bone affected and the severity of the disorder.

The pain in the bones generally increases, when the individual rests, when lifting heavy articles and at night. The pelvic bones are the most commonly affected bones while it may also be noticed in other bones such as those of the spinal cord, legs and skull. The teeth may become loose if the jaw bone is affected.

The affected individuals are more prone to develop osteoarthritis and suffer from kidney stones. In very rare cases, the bone cells may undergo cancerous changes.

Causes of paget’s disease

The exact cause of Paget’s disease has not yet been confirmed, while viral infection and genetic factors have been known to play a vital role in the occurrence of the disease.

Other factors that may have a role in the incidence of Paget’s disease include calcium intake and prolonged exposure to industrial toxins.

The Paget’s disease is initially characterized by excessive bone destruction and is followed replacement of the destroyed bone by a new type of bone that is weaker.1

Risk Factors for paget’s disease

Following are the possible risk factors for pagets disease of the bone.

  • Family history of Paget’s disease,
  • Over 50 years of age,
  • Low dietary intake of calcium
  • Chronic exposure to industrial toxins

Diagnosis of paget’s disease4

The diagnosis of Paget’s disease is most often based on the routine laboratory investigations and radiographs for other disorders. In case of individuals who are symptomatic, the diagnosis is based on the signs and symptoms noticed. Additional tests that are advised include blood tests to identify some of the factors specifically increased in case of individuals with Paget’s disease and radiographs to identify the changes in the bone. These two tests are considered to be important for the diagnosis of Paget’s disease.

In certain rare cases where the diagnosis is not possible by these tests, a biopsy of the bone may be advised.

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Treatment of paget’s disease

Paget’s disease cannot be cured. However, the amount and severity of bone destruction can be effectively minimized with use of certain specific medications. The medications that belong to the group of bisphosphonates are helpful in reduction of the bone destruction process and remain effective for a long period of time after the course of the medication is completed. These are generally advised in the form of tablets or injections that are to be taken daily for a certain period of time (2–6 months) depending on the severity and stage of the disease. Pain may be relieved with the use of certain stronger medications advised by the doctor. In cases where the bone deformity is severe or the associated symptoms are not relieved with the medications, surgical correction may be required.4,5

Alternative therapy for paget’s disease     

No alternative therapeutic modalities are helpful in Paget’s disease. Mild exercises may be advised in certain cases but a doctor’s advice should always be taken before initiation of any type of exercise as it may lead to fracture of the weakened bones.

Prevention of paget’s disease

Paget’s disease cannot be prevented though the severity of the disease and its progression can be prevented with early diagnosis and prompt treatment.

Complications of paget’s disease

The possible complications of Paget’s disease include bone deformity or fracture of the affected bones, heart failure (in severe cases), increased concentration of calcium, deafness and loosening of the teeth due to microfracture of the bone that supports the teeth.

Living with paget’s disease of paget’s disease

Paget’s disease is a long-term disorder that may be asymptomatic for a prolonged duration. Prompt treatment can result in decrease in the rate of bone destruction. However, periodic visit to the doctor is necessary to monitor the progression of the condition.4

References:

1. Ankrom MA. Shapiro JR. Paget’s disease of bone (osteitis deformans). J Am Geriatr Soc. 1998; 46: 1025–1033.

2. Roodman DG, Windle JJ. Paget disease of bone. J. Clin. Invest. 2005; 115(2): 200–208.

3. Griz L, Caldas G, Bandeira C, Assunção V, Bandeira F. Paget’s disease of Bone. Arq Bras Endocrinol Metab. 2006; 50(4): 814–822.

4. Schneider D, Hofmann MT, Peterson JA. Diagnosis and treatment of Paget’s disease of bone. Am Fam Physician. 2002; 65(10): 2069–2072.

5. Langston AL, Ralston SH. Management of Paget’s disease of bone. Rheumatology. 2004; 43(8): 955–959.

Written by: healthplus24.com team

Date last updated: February 05, 2015