Paget's Disease (cont.)
How is Paget's disease diagnosed?
Paget's disease is diagnosed based on the X-ray appearance. Paget's disease
might also be detected with other imaging tests, such as a bone scan, MRI scan,
and CT scan. An enzyme that comes from bone called alkaline phosphatase is
frequently elevated in the blood of people with Paget's disease as a result of
the abnormal bone turnover of actively remodeling bone. This blood test is also
referred to as the serum alkaline phosphatase (SAP).
The bone scan is particularly helpful in determining the extent of the
involvement of Paget's disease as it provides visualization of the entire
skeleton.
How is Paget's disease treated?
The treatment of Paget's disease is directed toward controlling the disease
activity and managing its complications. When Paget's disease causes no symptoms
and blood testing shows that the level of serum alkaline phosphatase is normal
or minimally elevated, no treatment may be necessary. Bone pain can require
antiinflammatory drugs (NSAIDs) or pain-relieving medications. Bone deformity
can require supports such as heel lifts or specialized footwear. Surgical
operations may be necessary for damaged joints, fractures, severely deformed bones,
or when nerves are being pinched by enlarged bone. Prior to undergoing an
operation on bone affected by Paget's disease, it is helpful to be treated with
medications, such as bisphosphonates or calcitonin (Miacalcin), as this tends to diminish
the risk of surgical complications, including bleeding.
The medical treatment of the bone of Paget's disease involves either
medications called bisphosphonates or injectable calcitonin.
Bisphosphonates are the mainstay of treatment. There are a number of these
available that are taken by mouth, including alendronate (Fosamax), risedronate
(Actonel), etidronate (Didronel), and tiludronate (Skelid), and that are
administered intravenously, including pamidronate (Aredia) and zolendronate (Reclast).
In general, oral bisphosphonates are taken first thing in the morning on an
empty stomach with 8 ounces of water. They can cause irritation of the stomach
and esophagus. Intravenous bisphosphonates can cause temporary muscle and joint
pain.
Next: What is the outlook for Paget's disease? »
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