Paget’s Disease Treatment – Bone

Paget’s disease of bone interferes with your body’s normal recycling process, in which new bone tissue gradually replaces old bone tissue. Over time, the disease can cause affected bones to become fragile and misshapen. Paget’s disease of bone most commonly occurs in the pelvis, skull, spine and legs. What Is Paget’s Disease Of Bone? Paget’s disease of bone is a condition that can cause bone fragility, deformity, and fracturing. Its symptoms are associated with the bones and diagnosis involves mainly imagery tests. Treatments can involve medication, surgery. This is an abnormal body conditioning in which new bone tissues gradually replace old bone tissues causing the affected bones, over time, to become fragile and misshaped. Because Paget’s disease causes your body to form new bone faster than normal, the rapid development, therefore, produces bones that are softer and weaker than normal bones, with resultant bone pain, deformities, and fractures. Paget’s disease of bone always affects the pelvis, spine, skull, and legs. Risk Groups Some factors can increase your chance of having Paget’s disease of bone. These risk factors include:

• Family History

Genetic lineage improves your risk of having Paget’s disease of bone.

• Nationality

paget’s disease of bone is more common among Scottish and English. Also in Central Europe, Greece, and other countries where there are European immigrants. It is rare among Asians and Scandinavians.

• Gender

Males are more prone to Paget’s disease of bone than females.

• Age

People above 40 years old are most likely to develop the condition. Diagnosis Physical Examination Your doctor will go through your medical history and examine areas of your body for signs of the condition. Further tests may be ordered for confirmation of the exact diagnosis. Imaging Test

• X-rays: To reveal bone abnormalities such as bone reabsorption, enlargement of bone, and bone deformities (bending, fracture, etc.)
• Bone Scan: Carried out with a simple photon emission computed tomography (SPECT), to create a 3-D image of the affected bone to see deeper into the bones. This can indicate whether you have a bone disorder, such as cancer or arthritis, or infection in the bone.

Lab Tests

• Blood Test: Paget’s disease of bone patients usually have high levels of alkaline phosphatase in their blood. This can be revealed by a blood test.

Treatment Medications

• The administration of osteoporosis drugs (Bisphosphonates). These drugs are of two types; oral and injection.

The oral bisphosphonates include:

1. Alendronate (Fosamax)
2. Pamidronate(Aredia)
3. Ibandronate (Boniva)
4. Risedronate (Actonel)
5. Zoledronic acid (Zometa, Reclast).

• Hormonal drug (Calcitonin); administered by injection or nasal spray 

Surgery Paget’s disease of bone rarely demands surgery. In rare situations, however, surgery might be needed for the following reasons:

• To heal fractures
• Realign deformed bones
• Relief affected bones
• Replace damaged joints.

Before the surgery procedure, medication might be prescribed to help reduce the loss of blood during the operation. Complications Some complications associated with Paget’s disease of the bone may include:

• Bone cancer

About 1% of people with Paget’s disease of bone suffer from bone cancer.

• Osteoarthritis

The amount of stress on nearby joints can result in osteoarthritis on the knee or hip.

• Osteoporosis

The weak bone may cause fractures and deformities. Legs may bend (bowlegs) and affect the ability to walk.

• Neurologic problems

In areas where nerves pass through the bone like the skull and spine, overgrowth of bone can compress and damage the nerve. Pain, weakness, and/or tingling in the arm or leg, as well as hearing loss, may occur.

• Failure of the heart

Paget’s disease of bone can hinder or reduce blood flow. This can force the heart to overwork to restore normal blood flow. The increased labor can lead to heart failure. Mortality Rate It has been observed that the 5-year survival rate for those with Paget’s disease and sarcoma ranges between 5% to 7.5%. Food Requirements There is no specific diet for Paget’s disease of the bone patient to prevent or treat the disease. For healthy bones, eat a balanced diet rich in calcium and vitamin D.The recommended daily intake of calcium for adults is 1000mg per day. Drink much water daily. The risk of Paget’s disease of bone increases with age. Your risk also increases if any family members have the disorder. Complications of Paget’s disease of bone can include broken bones, hearing loss and pinched nerves in your spine. Bisphosphonates the medications also used to strengthen bones weakened by osteoporosis are the mainstay of treatment. For patients who have complications, surgery may be necessary.

Symptoms

Most people who have Paget's disease of bone have no symptoms. When symptoms occur, the most common complaint is bone pain.

Symptoms

Paget's disease of bone has no symptoms. However, in some individuals, the most common complaint is a pain in the bone.

Signs and symptoms of Paget's disease are bone depend on the affected part of the body. Four parts are usually involved, these are:

• Pelvis; hip pains.
• Skull; loss of hearing and/or headache.
• Spine; nerve roots are compressed, resulting in pains, tingling, and numbness in the arms and legs.
• Legs; weak bones, bent or enlarged bones, osteoporosis, cartilage breakdown, and joint pains (osteoarthritis) on the knee or hip.

Because this disease causes your body to generate new bone faster than normal, the rapid remodeling produces bone that's softer and weaker than normal bone, which can lead to bone pain, deformities and fractures.

The disease might affect only one or two areas of your body or might be widespread. Your signs and symptoms, if any, will depend on the affected part of your body.

• Pelvis: Paget's disease of bone in the pelvis can cause hip pain.
• Skull: An overgrowth of bone in the skull can cause hearing loss or headaches.

• Spine: If your spine is affected, nerve roots can become compressed. This can cause pain, tingling and numbness in an arm or leg.
• Leg: As the bones weaken, they may bend causing you to become bowlegged. Enlarged and misshapen bones in your legs can put extra stress on nearby joints, which may cause osteoarthritis in your knee or hip.

Causes

Causes

Up to date, the cause of Paget's disease of bone is unknown. Scientist suggests a combination of genetic and environmental factors contribute to the disease.

Researchers have identified variations in 3 genes that are linked to Paget's disease of bone. They are:

• SQSTM 1
• TNFRSF 11A
• TNFRSF 11B

The axiological condition behind bone remodeling begins with excessive bone reabsorption followed by an increase in bone formation. A new tender bone re-emerges, weak and fragile, and can not stand harsh conditions. The weak bone develops pains and is deformed when it encounters stress and end up fractured.

FAQ

Is Paget's bone disease chronic?

Paget's disease of bone is a chronic bone disorder. It has no cure but symptoms can be managed with bisphosphonates and hormonal drugs.

What does Paget's disease of the bone look like?

X-ray diagnosis provides images of dense structures such as bone. A bone affected by Paget's disease usually appears enlarged and dense than a normal bone. It may be deformed. Bones of the leg may look bowed.

What are the stages of Paget's disease?

There are 3 phases of Paget's disease of bone; lytic, mixed lytic and plastic, and sclerotic.

• Lytic lesions are spots of damaged bones that result from cancerous plasma cells building in your marrows.
• Blastic lesions are the extra cells that build up.
• Sclerotic lesions are the unusual hardening and thickening of the bones.

Is Paget's disease a form of arthritis?

People sometimes confuse Paget's disease of bone with arthritis because Paget's disease pain may be located on the part of the bone closest to a joint. However, Paget's disease can cause arthritis overtime due to extra stress on nearby joints.

How is Paget's disease of bone different from osteoporosis?

Osteoporosis involves the weakening of bones of the body. The bones are reabsorbed by the body. This abnormality affects bones in all parts of the body. However, in the case of Paget's disease of bone, the unhealthy process of bone reabsorption by the body is located in just one or a few bones.