What Is Paget's Disease of the Bone?

Paget's disease of the bone is an interruption of the natural remodeling process where your body replaces older bones with new bones. The interruption accelerates the remodeling process and produces bigger, misshapen, and fragile bones. Pain, injury, and deformity are common symptoms. There is no known exact cause of Paget's disease. Adults over the age of 55 are more at risk.

Signs & Symptoms

Paget's disease symptoms are often very subtle and can easily be mistaken for other conditions. Many individuals do not initially experience any noticeable symptoms. The disease can occur anywhere in the body but is most common in your pelvis, legs, skull, and spine.

Paget's disease of the bone symptoms:

• Pain—You may feel hip pain, spine pain, leg pain, and headaches. The intensity of the pain depends on the location of the disease, severity of the condition, and how widespread the disease is in your body.
• Deformity—Rapidly produced new bone is often abnormally shaped and sized.
• Weakness—When bone is generated too quickly, it is often weaker and more prone to injuries.
• Fractures—You will likely experience an increase in bone fractures.
• Compression—Enlarged bones can compress soft tissue and nerves. This causes pain, numbness, tingling, loss of movement, and weakness.
• Hearing loss—If Paget's disease affects your skull, you can experience hearing issues or hearing loss.
• Arthritis—Damaged cartilage and excess pressure on your joints can cause arthritis.

Causes

There are no known specific Paget's disease causes, but there are several theories. For example, doctors believe that age, genetics, and environmental factors play a role in the development of the condition.

Risk Factors

Medical experts recognize several common risk factors for Paget's disease of the bone.

Paget's disease risk factors:

• Age—Paget's disease usually affects people over 55 years old. The condition rarely is seen in anyone under 40.
• Genetics—You are more likely to develop Paget's disease if a close relative also has the condition.
• Ancestry—Paget's disease affects a higher percentage of people of Anglo-Saxon and northern European origin. Individuals who reside in certain geographic regions—including the United States, New Zealand, England, and Australia—are more at risk. The disease poses less risk to those who live in Japan, India, China, and Scandinavia.
• Environmental Factors—Research suggests a potential link between environmental factors and Paget's disease of the bone.

Diagnosis

Your doctor will make a Paget's disease diagnosis after a review of your medical history and general physical exam. Your doctor may also use imaging and laboratory tests to confirm a diagnosis.

X-Ray

X-ray images help your doctor see how the disease affects your bones. X-rays can reveal deformities and injuries.

Bone Scan

Your doctor may perform a bone scan to determine if Paget's disease has affected bones in your body. A bone scan is a nuclear imaging technique that involves injecting small amounts of radioactive substances into your bloodstream.

As the tracer flows through your blood, it is selectively absorbed by areas of increased bone turnover. That data, collected with a special camera, can create an information-rich picture from which your doctor can make a diagnosis.

Laboratory Tests

Your doctor may also order blood or urine tests to check for abnormalities in the levels of certain minerals and enzymes. These elevated levels are common with high bone turnover.

Biopsy

In some cases, a biopsy is performed to confirm a Paget's disease diagnosis. During a biopsy, your doctor will remove a small amount of bone for examination under a microscope.

Treatment

Paget's disease treatment can include medication, physical therapy, and surgical procedures. Lifestyle changes in nutrition and exercise can reduce potential complications.

Medication

Your doctor might prescribe medication along with other Paget's disease of the bone treatments. The goal of medication is to relieve pain and inflammation. In more serious forms of the condition, your doctor may prescribe bisphosphonates to slow down the progression of the disease.

Physical Therapy

Your doctor may recommend physical therapy to relieve pain, strengthen your body, improve your mobility, and prevent injury.

Surgery

Your doctor may perform surgery for Paget's disease if you do not respond to other treatments or if you experience serious symptoms. The surgery your doctor recommends depends on the severity of your condition and where the disease is located. Procedures may include reshaping your bones, correcting deformities, and replacing joints.

Potential surgical options:

• Osteotomy—In an osteotomy, your doctor cuts and reshapes the bone to improve its function, reduce pain, and relieve weakened joints.
• Internal fixation—During this procedure, your doctor inserts metal pins, screws, or plates into the bone to keep it in place.
• Joint replacement—A total joint replacement is occasionally needed. This involves surgically removing the damaged joint and replacing it with an artificial one.

Complications

Paget's disease usually progresses slowly. Therefore, most individuals living with Paget's disease find that the condition is manageable with few complications. However, complications are possible.

Complications of Paget’s disease:

• Nerve damage—Overgrown bone can squeeze and damage nearby nerves.
• Fractures—Fragile bones can break more easily.
• Deformities—Enlarged or misshapen bones can affect your posture and ability to walk.
• Osteoarthritis—Abnormally shaped bones can put stress on your joints. Over time, this can lead to osteoarthritis, a condition in which the cartilage that protects your joints wears away.
• Heart trouble—If your heart is forced to pump harder to send blood to your body, it may malfunction. Although rare, heart failure is possible.
• Bone cancer—This complication is extremely rare. Doctors do not know exactly what causes the condition to worsen into cancer.

Paget's disease prognosis is generally optimistic. The outcome of treatment depends on many factors, including your age, health, and the severity of the condition. A healthy diet and exercise can further help strengthen your bones and improve your quality of life.

If you or one of your loved ones experience any of the symptoms of Paget's disease of the bone, an orthopedic surgeon at Baptist Health may be able to help.