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Paget’s disease and bone remodeling
Paget disease is a common condition characterized by a disruption of the body's normal bone recycling process. Symptoms include bone or joint pain, tenderness or redness, problems with balance, numbness or tingling in limbs, sciatica pain, headaches, loss of vision, and hearing loss.
Paget or Paget's disease of bone is a common condition characterized by a disruption of the body's normal bone recycling process. It is the second most common type of bone disease after osteoporosis.
Your bones are typically in a constant state of change, with new bone replacing old regularly. With Paget’s disease, your body breaks down older bone more quickly than your body can replace it with new bone. Around 1% of adults in the U.S. have Paget’s disease.
The disease is more common in older adults and those with a family history of Paget’s disease. It typically affects the bones of the pelvis, skull, legs—femur, tibia—and spine. Complications of the disease may lead to fractures, bone pain, and deformities.
Signs and symptoms of Paget disease of bone
Many people with Paget’s disease show no symptoms and have no outward signs of the disease. They may also mistake any symptoms they are experiencing for arthritis. People with Paget’s disease may notice some of the following signs:
Bone or joint pain
One of Paget’s disease's most common symptoms is pain in the bones and inflammation and swelling in joints of the affected region of the body.
Tenderness or redness in the affected area
Affected regions of the body may show outward physical signs such as tenderness or redness of the skin due to increased blood flow. These areas may also feel warm to the touch.
Problems with balance
Individuals with Paget’s disease may experience problems with balance associated with the restriction of a normal range of movement.
Numbness or tingling in limbs
As Paget’s disease progresses, it will often lead to deformations in bone growth. When these deformations occur along your spinal column, the spinal nerve roots may experience pressure, leading to numbness and tingling in the limbs, neck, and shoulders. This numbness and tingling are known as peripheral neuropathy.
Sciatica pain
Sciatica pain begins along the spine and moves downward through the leg muscles.
Headaches, loss of vision, and hearing loss
Individuals with Paget’s disease in the skull often experience headaches. In some cases, loss of vision and hearing has been experienced.
Types of Paget’s disease
There are two different types of Paget’s disease of bone:
- Monostotic: A single bone site is affected.
- Polyostotic: Multiple sites of bone are affected.
Causes of Paget’s disease
Scientists don’t know exactly what causes Paget’s disease. However, environmental factors such as prior breaks or bone injury early in life may make you more susceptible. You’re more likely to develop it if you have a family history of Paget’s disease — scientists theorize that several genes are linked to the disease.
When to see the doctor for Paget’s disease
If you’re experiencing pain in bones or joints, you may be wondering when to see the doctor. It’s often hard to determine if the pain you feel in your body is normal soreness or an indicator of a more serious underlying condition.
Many people don’t know they have Paget’s because the symptoms don’t seem very severe, aren’t present, or are mistaken for arthritis. A doctor can examine you and run tests to determine if you have Paget’s, if you have any of the following symptoms:
- Pain
- Headaches
- Enlarged bones
- Bowing of an arm or leg
- Hearing loss
- Joint pain
Diagnosing Paget’s disease
People are often diagnosed with Paget’s disease after going to see their doctor for other medical reasons. The most common methods of diagnosing Paget’s disease are:
X-ray
An X-ray is the most common procedure for diagnosing Paget’s disease in patients and is used for evaluating bone structure.
Blood test
Sometimes a doctor will order a blood test to check a patient for Paget’s disease. However, it is more commonly found via blood work being performed for another reason.
A bone scan is performed by injecting a low-level, safe amount of radioactive liquid into your bloodstream. The radioactive substance is circulated throughout your body, collecting in the areas of the body with increased blood flow and bone-forming activity.
Treatments for Paget’s disease
If you are diagnosed with Paget’s disease but not experiencing symptoms, it may be unnecessary to treat the condition, and your doctor may wait to see if you develop symptoms over time. If the affected bones are in an area more likely to result in severe complications, such as the skull, your doctor may choose to begin treatment immediately to slow down or stop the disease from progressing.
Medications
There are two main types of medications that your doctor may choose to prescribe for the treatment of Paget’s disease:
- Bisphosphonates: This drug works by limiting and controlling the excessive breakdown and reformation of bones caused by Paget’s disease.
- Calcitonin: Your doctor may prescribe daily injections of calcitonin instead of bisphosphonates. Calcitonin is a hormone responsible for regulating calcium and phosphate levels in the bloodstream.
Surgery
In some circumstances, as in the case of complications arising from Paget’s disease, your doctor may choose to perform corrective surgery.
Because Paget’s is a disease of the bone, it’s essential to make sure your body is receiving an appropriate amount of calcium and vitamin D to ensure the health of your bones. Moderate exercise is also recommended to maintain muscle definition, skeletal health, and the mobility of joints.