Paget’s disease of the bone is generally found to interfere with the normal recycling process of the body in which newer bone tissues are found to gradually replace older bone tissue. This disease can cause affected bone to become fragile over time & eventually misshapen. Most commonly, Paget’s disease commonly occurs in pelvis, legs, spine & skull. Moreover, risk of Paget’s disease of bone increases with the age of a person. This risk is also found to increase in case any family members are found to have this disorder. Complications of Paget’s disease of bone, generally includes broken bones, pinched nerves in spine & hearing loss. Biophosphonates are common medications which are utilized for strengthening of bones which are weakened by osteoporosis. Although, this is the mainstay of Paget’s disease of bone treatment, surgery may also be necessary in severe cases.
Signs & Symptoms of Paget’s Disease of Bone
Most people having Paget’s disease of bone experience no symptoms. However, whenever symptoms occur, the most common complaint among these patients is bone pain. Since this disease pushes the patient’s body to generate newer bone faster than the normal pace, the act of rapid remodeling produces bones which are weaker & softer than normal bones & which can eventually lead to fractures, deformities & bone pain. It is also possible that Paget’s disease of bone to affect only one or two areas of the body, or might even be widespread in some cases. Nevertheless, signs & symptoms of Paget’s disease of bone patients, if any, will normally depend upon the affected parts of the body.
- Pelvis – Paget’s disease of bone occurring in pelvis will usually cause pain in hips.
- Leg – Since bones are weakened in Paget’s disease of bone patients, they may in some cases bend so as to cause bowlegs. Enlarged & misshapen bones in legs can subsequently put extra stress on joints located nearby & which may also cause osteoarthritis in knee or hip joints.
- Spine – When a Paget’s disease of bone patient’s spine is affected, it can cause nerve roots to become compressed & result in experiencing numbness, tingling & pain in arms or legs.
- Skull – Overgrowth of bone in skull among Paget’s disease of bone patients can cause headaches or hearing loss.
Causes of Paget’s Disease of Bone
Actual causes of Paget’s disease of bone are still unknown. However, scientists suspect a combination of genetic & environmental factors which contribute to this disease. Several genes also appear to be linked to development of this disease. In spite of this understanding of the disease, some scientists believe that Paget’s disease of the bone is related to some kind of viral infection within bone cells, but then, this is a theory which is quite controversial.
Risk Factors Associated with Paget’s Disease of Bone
Factors which are generally found to increase risk of Paget’s disease of the bone include the following.
- Age – People who are older than 40 years of age are most likely to develop Paget’s disease of the bone.
- Gender – Men are more commonly found to be affected by Paget’s disease of the bone than women.
- Family History – Having a close relative with Paget’s disease of the bone makes an individual more likely to develop this condition.
- National Origin – Paget’s disease of the bone is found to be more common in places like Greece, Central Europe, Scotland & England & among countries settled by European immigrants. However, this disease is uncommon in Asia & Scandinavian countries.
Complications Associated with Paget’s Disease of the Bone
Paget’s disease of the bone in most patients progresses very slowly. However, this disease can be effectively managed in nearly all cases. Nevertheless, possible complications of Paget’s disease of the bone include the following.
- Fractures & Deformities – Bones which are affected by Paget’s disease are found to break more easily. Moreover, presence of extra blood vessels within these deformed bones can cause them, to bleed more easily during surgical repairs. Bowing of bones of legs among Paget’s disease patients can also affect their ability to walk.
- Osteoarthritis – Misshapen bones caused due to Paget’s disease can increase amount of stress which is exerted on nearby joints & which can eventually cause osteoarthritis as well.
- Heart Failure – Extensive spread of Paget’s disease of bone can force heart to work harder so as to pump blood to affected areas of the patient’s body. Moreover, this increased workload can also lead to heart failure among people with pre-existing heart diseases.
- Bone Cancer – Bone cancer is found to occur among less than 1 percent of the people who are affected with Paget’s disease of the bone.
Diagnosing Paget’s Disease of the Bone
Orthopedists would usually examine areas of the body which are causing pain during physical examination. They may also order blood tests & x-rays which will help them confirm diagnosis of Paget’s disease of bone.
- Imaging Tests for Paget’s Disease of the Bone
Changes to bones are common to Paget’s disease of bone patients & which can be revealed by the following tests.
- X-Rays – First indication of Paget’s disease of the bone is most often abnormalities which are found on x-rays which were performed for other reasons. Images of x-rays of bones can show enlargement of bone, areas of bone re-absorption & deformities which are characteristic of Paget’s disease of the bone, like bowing of the long bones.
- Bone Scans – Radioactive material is injected into the body of the patient for bone scans. This material will eventually travel to spots on bones which are most affected by Paget’s disease of the bone, so that these get highlighted upon the scanned images.
- Laboratory Tests for Paget’s Disease of the Bone
People having Paget’s disease of the bone will usually show elevated levels of alkaline phosphatase within their blood. This can also be effectively revealed through blood tests.
Initial Appointment for Paget’s Disease of the Bone
People experiencing the following symptoms should seek appointments with doctors.
- Pain in Bone & Joints
- Weakness & Tingling
- Bone Deformities
Preparing for Initial Appointment
Most often, people with Paget’s disease of the bone do not experience any signs or symptoms are only diagnosed when x-rays or blood tests are taken for some other reason. However, in some cases patients are referred to endocrinologists who specialize in metabolic & hormonal disorders or rheumatologists specializing in muscle & joint disorders. Since appointment with specialist doctors are brief & short, it would be sensible for patients to stay prepared for initial appointments. Here is a list of some information which can help patients prepare for the appointment.
Patients Should Take the Following Steps
While making an initial appointment, patients must enquire if there is anything they will need to do in advance, like fasting before undergoing specific tests. It would be ideal for a patient to take a friend or family member along with him/her to the initial appointment. This can help patients remember some things which were discussed during the appointment & the patient may have forgotten to remember. Moreover, patients should also make a list by including the following information.
- Symptoms – This should also include any symptoms which seem unrelated to the reason for appointment.
- Key Personal Information – This information should also include major stresses & recent changes in life along with medical history of the family.
- List of Medications – Apart from medications, this list must also include doses of vitamins & other supplements which the patient is presently taking.
- List of Questions to Ask Specialist Doctors – Some basic questions which Paget’s disease of the bone patients can ask specialist doctors include the following.
- What is it that is most likely causing my symptoms?
- What other possible causes could be there which are causing these symptoms?
- Which tests will I need to undergo?
- Is this condition likely to be temporary or chronic in nature?
- Which is the best course of action in this case?
- What alternatives do I have to the primary approach you are suggesting?
- How best can I manage this condition along with my other health problems?
- Are there any restrictions which I need to follow?
- Do I need to see any other specialist?
- Can you provide me with brochures or other printed material on Paget’s disease of the bone?
- Which websites would you recommend I visit for more information on the subject?
However, patients must not hesitate to ask any other questions which come to their mind during the initial appointment.
- List of Questions Which Specialist Doctors Usually Ask Patients
Specialist doctors are most likely to ask some of the following questions during initial appointment.
- Have you been experiencing any tingling or numbness?
- Have you lately experienced any muscle weakness?
- Are you having any new headaches?
- Are you recently experiencing any worsening of hearing?
Treatment Options for Paget’s Disease of the Bone
Quite often when patients do not experience, they would require no treatments at all. However, in case the disease is active, it will be indicated by elevated levels of alkaline phosphatase which is affecting high-risk locations in the body like spine or skull. Nevertheless, doctors usually recommend treatments to prevent complications even when patients are not having any symptoms.
- Medications for Paget’s Disease of the Bone
Bisphosphonates which are drugs for osteoporosis are the most common treatment options for Paget’s disease of the bone. Some bisphosphonates are consumed orally while other are injected into the system. Although, oral bisphosphonates are normally well tolerated by patients, they may at times irritate the gastrointestinal tract. Commonly used bisphosphonates include the following.
- Risedronate (Actonel)
- Pamidronate (Aredia)
- Ibandronate (Boniva)
- Alendronate (Fosamax)
- Zoledronic Acid (Reclast, Zometa)
It is quite rare that bisphosphonate therapy is linked to severe bone, joint or muscle pain, which might not resolve even when the medication is discontinued. Moreover, bisphosphonates are sometimes also found to increase risk of a rare condition which involves deterioration or death of a section of jawbone (osteonecrosis of jawbone) & which is usually associated with tooth extraction or a dental disease. Doctors may also prescribe calcitonin (Miacalcin) for patients who cannot tolerate bisphosphonates. This is a naturally occurring hormone which is involved in regulation of calcium & bone metabolism. Calcitonin is a drug which is administered by injection or nasal sprays by the patient himself. Side effects of calcitonin generally include facial flushing, nausea & irritation at the site of injection.
- Surgery for Paget’s Disease of the Bone
Surgery may be required in rare cases of Paget’s disease of the bone in the following conditions.
- Help healing of fractures
- Replace joints which are damaged by severe arthritis
- Realigning deformed bones
- Reducing pressure upon nerves
Paget’s disease of the bone quite often causes the body to produce several blood vessels in affected bones & which eventually increases risk of serious blood loss during surgical intervention. Therefore, orthopedic surgeons may prescribe medications to reduce disease activity & blood loss during surgery for Paget’s disease of the bone patients who are scheduled for surgery.
Self-Management – Lifestyle Changes & Home Remedies for Paget’s Disease of the Bone
Paget’s disease of the bone patients should try the following tips in order to reduce risks which are normally associated with this condition.
- Prevent Falling – Paget’s disease of the bone puts patients at higher risk of developing bone fractures. Patients should therefore ask doctors for advice on preventing falls. Doctors may recommend patients use a walker or canes for this reason. It is also suggested that patient fall-proof their home environment. For this purpose they can remove slippery floor coverings, tuck away cords, use non-skid mats in shower or bathtub & install grab bars in bathroom & handrails on stairways.
- Eating Well – Paget’s disease of the bone patients must ensure that their diet includes adequate amounts of vitamin D & calcium in order to help bones absorb calcium. This is especially more important for patients taking bisphosphonates. They must also review their diet with doctors & enquire if it is okay for them to take vitamin & calcium supplements.
- Exercising Regularly – Regular exercises are most essential for maintaining bone strength & joint mobility. Paget’s disease of the bone patients must however talk with doctors before starting an exercise program in order to determine the correct type, duration & intensity of exercise which is right for them. They should bear in mind that some activities may place excessive stress on affected bones.
World-Class Treatments for Paget’s Disease of the Bone in India
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