Paget’s Disease

Paget’s disease of bone is a chronic disorder that can result in enlarged and misshapen bones. The excessive breakdown and formation of bone tissue causes affected bone to weaken, resulting in pain, misshapen bones, fractures, and arthritis in the joints near the affected bones. Paget’s disease typically is localized, affecting just one or a few bones, as opposed to osteoporosis, which usually affects all the bones in the body.

The cause of Paget’s is unknown. Some studies have suggested that the disease may be caused by a “slow viral” infection of the bone. In addition, there is also a hereditary factor, since the disease may appear in more than one member of the family. The hereditary factor may lead to susceptibility among family members to the suspected viral infection.

Paget’s disease is most common in Caucasian people of European descent, but it also occurs in African-Americans. It is rare in those of Asian descent. Paget’s disease is rarely diagnosed in people under 40, but may occur in up to 3% of the American population over 60. Both men and women are affected.

The most common symptom is bone pain. The pain may occur in any bone and often localizes to areas adjacent to the joints. Headaches and hearing loss may occur when Paget’ disease affects the skull.

The diagnosis is made by correlating the clinical findings with the blood level of alkaline phosphatase and in many cases the X-ray findings. If the alkaline phosphatase is elevated, other tests such as a bone-specific alkaline phosphatase test, bone scan or X-ray can be performed as a follow-up.

The treatment plan consists of the use of Bisphosphonates and calcitonin. Treatment can be very often successful in controlling the disease activity and can lessen the pain and other symptoms. If the treatment is started before complications begin, the management of the disease yields better results.

Exercise is also very important in maintaining skeletal health and patients with Paget’s should discuss an exercise program with their rheumatologist before beginning. It is important not to place undue stress on affected bones.

Author: Norman B. Gaylis, MD, FACP, FACR

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