Paget's disease is a chronic bone disorder that is caused by the irregular breakdown and regrowth of bone tissue. It can lead to enlarged and misshapen bones which can further lead to other bone and joint problems. It usually occurs in one bone but can involve many bones. Paget's disease is rarely diagnosed in people under 40 years of age. Men and women are approximately equally affected.

Alternative Names: Osteitis deformans.

Complications of Paget's disease

• Bone fractures.
• Deafness.
• Deformities.
• Heart failure.
• Paraplegia.
• Spinal stenosis.

Causes of Paget's disease
The cause of Paget's disease is unknown, although it is considered to be linked with genes or a viral infection at young age.

Signs & Symptoms of Paget's disease
Most patients have no symptoms. Sometimes, symptoms may be confused with those of arthritis or other disorders. In other cases, the diease is diagnosed only after complications have developed.

Symptoms can include:

• Bone pain which maybe severe and persistent.
• Bowing of the legs and other visible deformities.
• Enlarged head.
• Fracture.
• Headache.
• Hearing loss.
• Joint pain or stiffness.
• Neck pain.
• Reduced height.
• Skull deformities.
• Warmth of skin over the affected bone.

Diagnosis of Paget's disease

• X-rays:  X-rays can show pagetic bone appearance.
• Alkaline phosphatase test: An elevated level of alkaline phosphatase in the blood may suggest paget's disease.
• Bone scan: This is useful in determining the extent and activity of the condition. If a bone scan suggests Paget's disease, the affected bone or bones should be x-rayed to confirm the diagnosis.

Treatments of Paget's disease
Treatment is not required for all patients. For example, only patients who have abnormal blood tests may need treatment.

However treatment will be required for the following:

• Patients with deformities.
• Patients with no symptoms when certain bones such as weight-bearing bones are involved and especially if the bony changes are progressing quickly.
• Patients with symptoms.

Treatment involves:

1) Drug therapy:  Drugs help prevent further bone breakdown.

Various types of drugs that are used are :

• Bisphosphonates:  These drugs help to increase bone density.

Types of bisphosphonates include:

a) Alendronate (Fosamax)
b) Etidronate (Didronel)
c) Pamidronate (Aredia)
d) Risedronate (Actonel)
e) Tiludronate (Skelid)
f) Zoledronic acid (Zometa)

• Calcitonin : It is atype of hormone involved in bone metabolism.

Types of calcitonin include:

a) Intranasal (Miacalcin)
b) Subcutaneous (Calcimar)

• Plicamycin (Mithracin)

• NSAIDS: Non-Steroidal Anti-Inflammatory Drugs or analgesics may also be given for pain.

2) Orthopedic surgery - It may be required to correct a specific deformity in severe cases.

Prevention of Paget's disease

• Paget's disease cannot be prevented. But its further effects and complications like osteoarthritis, can be prevented by taking medicine.
• In general, people with Paget's disease should receive 1,000-1,500 mg of calcium, adequate sunshine, and at least 400 units of vitamin D daily.
• Exercise is very important in maintaining skeletal health, avoiding weight gain, and maintaining joint mobility. Exercise program should be followed in consulatation with physician before beginning.

When to seek Medical Advice
Whenever you develop symptoms of paget's disease.