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Definition:

Paget's disease is a disorder that involves abnormal bone destruction and regrowth, which results in deformity.



Alternative Names:

Osteitis deformans



Causes, incidence, and risk factors:

The cause of Paget's disease is unknown, although it might have to do with genes or a viral infection early in life.

The disease occurs worldwide, but is more common in Europe, Australia, and New Zealand.

In people with Paget's disease, there is an abnormal breakdown of bone tissue, followed by abnormal bone formation. The new bone is bigger, but weakened and filled with new blood vessels.

The disease may only be in one or two areas of the skeleton, or throughout the body. It often involves bones of the:

  • Arm
  • Collar
  • Leg
  • Pelvis
  • Spine


Symptoms: Note: Most patients have no symptoms.

Signs and tests:

Tests that may indicate Paget's disease include:

This disease may also affect the results of the following tests:



Treatment:

Not all patients need treatment. For example, patients who have abnormal blood tests only may not need treatment.

People with Paget's disease who are commonly treated include:

  • Patients with deformities
  • Patients with no symptoms when certain bones (such as weight-bearing bones) are involved, especially if the bony changes are progressing quickly, to reduce the risk of fractures
  • Patients with symptoms

Drug therapy helps prevent further bone breakdown. Currently, there are several classes of medications used in the treatment of Paget's disease. These include:

  • Bisphosphonates -- These drugs are the first-line treatment, and they help increase bone density. Types of bisphosphonates include:
    • Alendronate (Fosamax)
    • Etidronate (Didronel)
    • Pamidronate (Aredia)
    • Risedronate (Actonel)
    • Tiludronate (Skelid)
    • Zoledronic acid (Zometa)
  • Calcitonin -- This hormone is involved in bone metabolism. Types include:
    • Intranasal (Miacalcin)
    • Subcutaneous (Calcimar)
  • Plicamycin (Mithracin)

Analgesics or nonsteroidal anti-inflammatory medications (NSAIDS) may also be given for pain.

Localized Paget's disease needs no treatment, if there are no symptoms and no evidence of active disease. Orthopedic surgery may be required to correct a specific deformity in severe cases.



Support Groups:

For additional support and resources, see the Paget Foundation .



Expectations (prognosis):

Disease activity and symptoms can generally be controlled with current medications. A small percentage of patients may develop a cancer of the bone called osteosarcoma . Some patients will need joint replacement surgery.



Complications:

Calling your health care provider:

Call for an appointment with your health care provider if you develop symptoms of Paget's disease.



Prevention:



References: Goldman L, Ausiello D. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007.


Review Date: 3/19/2008
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, Greg Juhn, MTPW, David R. Eltz, Kelli A. Stacy, ELS. Previously reviewed by Nancy J. Rennert, M.D., Chief of Endocrinology Diabetes, Norwalk Hospital, Associate Clinical Professor of Medicine, Yale University School of Medicine, New Haven, CT. Review provided by VeriMed Healthcare Network (12/6/2007).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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