Paget's Disease of Bone

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: Catherine Burt Driver, MD
    Catherine Burt Driver, MD

    Catherine Burt Driver, MD

    Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

What are Paget's disease symptoms and signs?

Paget's disease commonly causes no symptoms and is often incidentally noted when X-ray tests are obtained for other reasons. However, Paget's disease can cause bone pain, deformity, fracture, and arthritis. The bone pain of Paget's disease is located in the affected bone. The most common bones affected by Paget's disease include the spine, the thigh bone (femur), the pelvis, the skull, the collarbone (clavicle), and the upper arm bone (humerus).

The symptoms of Paget's disease depend on the bones affected and the severity of the disease. Enlarged bones can pinch adjacent nerves, causing tingling and numbness. Bowing of the legs can occur. Hip or knee involvement can lead to arthritis, limping, as well as pain and stiffness of the hip or knee. Headache, loss of vision, and hearing loss can occur when bones of the skull are affected. With very widespread Paget's disease, it is possible to develop congestive heart failure due to an increased workload on the heart.

How do health care professionals make a diagnosis of Paget's disease?

Health care professionals make a diagnosis of Paget's disease based on the X-ray appearance. Doctors also may detect Paget's disease with other imaging tests, such as a bone scan, MRI scan, and CT scan. Alkaline phosphatase, an enzyme that comes from bone, 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) and is used to monitor the results of treatment of Paget's disease.

The bone scan is particularly helpful in determining the extent of the involvement of Paget's disease as it provides an image of the entire skeleton. Bone that is affected by Paget's disease can easily be identified with bone scanning images.

What is the medical treatment for Paget's disease?

The medical 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 anti-inflammatory drugs (NSAIDs) or pain-relieving medicines. Bone deformity can require supports such as heel lifts or specialized footwear. Surgery may be necessary for damaged joints, fractures, severely deformed bones, or when nerves are being pinched by enlarged bone. Prior to undergoing surgery on bone affected by Paget's disease, it is helpful for doctors to treat patients 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 medicines called bisphosphonates or injectable calcitonin. Doctors use these drugs to treat certain patients with osteoporosis. Bisphosphonates are the mainstay of treatment. There are a number of medicines 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 zoledronate (Reclast). In general, oral bisphosphonates are taken first thing in the morning on an empty stomach with 8 ounces of water; the medicine can cause irritation of the stomach and esophagus. Intravenous bisphosphonates can cause temporary muscle and joint pain but are not associated with irritation of the stomach or esophagus.

Medically Reviewed by a Doctor on 11/9/2015

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