What is bone paget disease

It is a chronic skeletal disorder characterized by swollen and deformed bones in one or more bony areas.

What is the cause of paget disease

The cause of Paget’s disease has not been clarified. Genetic and environmental factors have been implicated and some disease-related genes have been found. The fact that there is heredity also follows from the fact that it can occur in more than one member of a family. Some researchers claim that the disease is due to a chronic mild viral infection but this is also a controversial theory.

Epidemiologic data

It is a rare disease with a prevalence of 1.5-8% depending on age and country. It rarely occurs in people under the age of 40 and affects women and men equally.

What are the symptoms of the disease

It is asymptomatic in many people and is suspected of being elevated alkaline phosphatase, an enzyme that can be measured in a routine blood test. The most common symptom is pain, usually in the area of the affected bone. There may also be headache or hearing loss when the skull is affected. In advanced disease, bone deformities such as enlargement of the skull, curvature of the limbs and spine can occur. Arthritis of the affected areas also coexists with age.

Which bones are affected

Any bone can be affected but most often the bones of the pelvis, skull, spine and lower extremities are affected. Some patients have a bone injury while others have two, three or more.

How the diagnosis is made

With imaging methods such as:

• X-rays of the affected areas, which have a characteristic appearance.
• Bone scintigraphy, which is a very sensitive examination.
• Also, blood alkaline phosphatase, an enzyme that is characteristic of the disease, is usually elevated. However, when the affected area is very small, alkaline phosphatase may be normal.

Is osteoporosis related to paget disease?

Although they may coexist in the same patient, these are two completely different conditions.

What is the relationship between paget disease and osteoarthritis

Paget’s disease increases the volume and deformity of the bones resulting in wear out of the joints of the affected areas.

Treatment

DIET: No special diet is needed but patients need 1000mg of calcium per day and 800 units of vitamin D for good skeletal health.

EXERCISE: Exercise is recommended for patients with Paget’s disease after first discussing with their doctor what is the appropriate form of exercise for their case.

MEDICINES: Drugs used in Paget’s disease belong to the group of bisphosphonates mainly risedronate and zolendronic acid in doses different from those used in osteoporosis, in order to keep the disease in long-term downturn.

SURGERY: There are 3 cases in which surgery is recommended:

• Firsty, when a fracture occurs in the bone suffering from the disease.
• Secondly, when severe degenerative arthropathy develops.
• Thirdly, for the correction of serious deformations.

Advises Mr. George Trovas, Endocrinologist, Scientific Associate of the Laboratory of Musculoskeletal Diseases Research