What does this do to your bones?
For the past several mornings, you have been waking up with pain in your hip. No matter what you try, it won’t go away. You go to your doctor, and after several tests, he tells you that you have Paget’s disease of the bone. What is this? What are the impacts going to be on your life? Is there a way to get rid of it?
Definition
Paget’s disease has two main classifications Paget’s disease of the bone and Paget’s disease of the breast. They’re not related to each other but are named similarly because they were both discovered by Sir James Paget, an English surgeon and pathologist in the 1800s. Paget’s disease of the breast is a rare form of breast cancer, whereas Paget’s disease of bone interferes with your body’s normal recycling process where new bone tissue gradually replaces old bone tissue. Given that they’re two different conditions, we’ll be focusing solely on Paget’s disease of the bone for this article.
To this day, the cause of Paget’s disease of bone is unknown. However, scientists suspect a combination of environmental and genetic factors because several genes appear to be linked to getting the disease. A controversial theory that some scientists believe is Paget’s disease of bone is related to a viral infection in your bone cells. For some unknown reason, the disease has become less common over the past several years and is less severe when it does appear.
Regardless of why it happens, the disease process results in the person’s bones becoming fragile and misshapen over time. This is from the body generating new bone faster than normal, which leads to rapid remodeling that causes less organized and weaker bone to be in the affected area. It’s most commonly seen in the pelvis, skull, spine, and legs. Sometimes, the disease only involves one or two areas. Other times, it’s widespread.
While most individuals have no symptoms, if they do develop, they vary depending on the area that’s impacted. If the pelvis is involved, the person usually has hip pain. Those whose skull is affected are likely to have headaches or hearing loss. If the disease is in the spine, it can result in the nerve roots becoming compressed, which causes pain, tingling, and numbness in an arm or leg. When present in the leg, the weakened bones can bend, making the person bowlegged.
Certain things can increase your chances of developing Paget’s disease of the bone, such as being over 50, being male, having a family history of the disorder, or being from/descendent of someone from England, Scotland, central Europe, or Greece. There are several potential complications of Paget’s disease of the bone. A major one is fractures and deformities because affected bones break more easily, and extra blood vessels in these deformed bones cause them to bleed more during repair surgeries. The person’s ability to walk can be compromised due to their bowed legs. Also, the enlarged and misshapen bones in the leg put extra stress on joints, which can cause osteoarthritis in the knee or hip. When Paget’s disease of the bone occurs where nerves pass through the bone, such as the spine and skull, the overgrowth of bone can compress and damage the nerve. In severe cases of the condition, the person’s heart may have to work harder to pump blood to the affected areas of your body due to the additional blood vessels, which increases the heart’s workload leading to heart failure. Bone cancer occurs in up to 1% of people with the condition.
Treatment
For Paget’s disease of the bone, if you don’t have symptoms, you might not need treatment. However, the disease can be active even if you don’t have symptoms. This is determined by blood testing looking for elevated alkaline phosphatase levels. If these are high and the disease is found in high-risk sites, like your skull or spine, your doctor might recommend treatment to prevent complications.
Medications used to treat Paget’s disease of the bone are the osteoporosis drugs bisphosphonates. They’re typically given by injection into a vein but can also be taken by mouth. Intravenous (IV) examples include zoledronic acid, pamidronate, and ibandronate. Oral bisphosphonates are alendronate or risedronate. They’re usually well tolerated when taken orally but can irritate the stomach. Rarely these medications have been linked to severe muscle, joint, or bone pain, which might not resolve when the medication is discontinued.
If you can’t tolerate bisphosphonates, your doctor might prescribe calcitonin. It’s a naturally occurring hormone involved in calcium regulation and bone metabolism. To take calcitonin, you either give yourself an injection or use nasal spray. The most common side effects are nausea, facial flushing, and irritation at the injection site.
In rare cases, you might need surgery to help fractures heal, replace joints damaged by severe arthritis, realign deformed bones, or reduce pressure on nerves. Since Paget’s disease of the bone often causes the body to produce too many blood vessels in the affected bones, there’s an increased risk of severe blood loss during an operation. So, if you’re scheduled for surgery, your doctor might prescribe medications to reduce the activity of the disease, which can help lessen blood loss.
Prevention
Unfortunately, there isn’t a way to prevent the disease itself. So, the priority is preventing complications to the best of your ability. You want to make sure your diet includes adequate levels of calcium and vitamin D, which helps bones absorb calcium. This is especially important if you’re taking a bisphosphonate. You might need to take vitamin and calcium supplements. Your doctor can help you decide this after reviewing your current diet. Another essential element is getting regular exercise because it’s essential for maintaining joint mobility and bone strength. Be sure to talk to your doctor before beginning an exercise program to determine the right type, duration, and intensity since some activities may place too much stress on your affected bones. Since Paget’s disease of the bone puts you at high risk of broken bones, you’ll want to prevent falls the best you can. To do this, you might need to use a cane or a walker, remove slippery floor coverings from your home, use nonskid mats in your bathtub or shower, tuck away exposed cords, install handrails on stairways, and put grab bars in your bathroom.
Paget’s disease of the bone can have a significant impact on your life. By doing everything you can to reduce its progression, you’ll be able to live your life to the fullest! If you have any questions or concerns about Paget’s disease, please speak with your doctor. If you would like more information, please visit American Academy of Orthopaedic Surgeons OrthoInfo’s Paget’s Disease of the Bone page at https://orthoinfo.aaos.org/en/diseases–conditions/pagets-disease-of-bone