Paget’s Disease: Know About the Symptoms, Causes And Latest Treatment Advancements Affecting This Bone Disease

by Dr. Chetan Rathod, Consultant Trauma & Replacement Surgeon, HCG Hospitals, Bhavnagar
Stronger and healthy bones help us to move, protect vital organs, and preserve nutrients that keep us hale and hearty. The bones are living tissues that constantly change. People reach their maximum bone mass around age 30 and then only natural remodelling happens, where old pieces of bone are removed and replaced with new bone. Bones hold a significant role in the system-providing structure, securing muscles, and preserving calcium.

Certain health conditions of bone can impede the body’s normal recycling process, where new bone tissue is constantly replaced by old bone tissue. This disease is known as Paget’s disease, a chronic condition affecting the skeleton. In Paget’s disease, the bones become brittle, weak, and twisted affecting mainly the pelvis, skull, spine, and legs
The risks of Paget’s disease increase with age and if it runs in the family, hereditary. Broken bones, hearing loss, and pinched nerves in the spine are some of the complications related to Paget’s disease.

Symptoms
People with Paget’s disease of bone show no symptoms and when symptoms develop, bone pain is the most common. This disease makes the body produce new bone faster than normal and fast remodelling creates bones that are weaker and misshapen than normal bone, this can result in bone pain, deformities, and fractures. Stronger and healthy bones help us to move, protect vital organs, and preserve nutrients that keep us hale and hearty. The bones are living tissue that constantly changes. People reach their maximum bone mass around age 30 and then only remodelling happens, where old pieces of bone are removed and replaced with new bone. Bones hold a significant role in the system-providing structure, securing muscles, and preserving calcium. Paget’s disease usually affects one or two regions of the body or may be widespread, the signs and symptoms if any, will depend on the affected region of the body, such as -
•         If Pelvis is affected, then Paget's disease of bone can cause hip pain.
•         In the Skull, an overgrowth of bone can cause hearing loss or headaches.
•         If the spine is affected, nerve roots can become compressed, resulting in pain, tingling, and numbness in an arm or leg.
•         In the legs, it may weaken the bone resulting in bowlegged. And enlarged and distorted bones in the legs can exert pressure on the nearby joints, which can lead to osteoarthritis in the knee or hip.

Treatment Advancements
There is no complete cure for Paget’s disease and no way to reverse its impact. The treatment mainly focuses on easing symptoms and averting future complications.
1.      Nonsurgical Treatments
If there is no pain or other symptoms, then no treatment is needed, however, your healthcare provider may constantly monitor your condition and regular X-rays are taken to look out for any changes affecting the bone and to make sure that complications do not occur.
Also, if symptoms develop your doctor may recommend non-surgical treatments, which include:
Nonsteroidal anti-inflammatory drugs (NSAIDs) help ease mild bone pain that arises from Paget’s disease or from arthritis that may be related to the disease.
Assistive Devices: If the pelvis or leg is affected by the disease, a supporting cane or walker can help alleviate pain by reducing the forces applied to the bone. It can also avert falls, thus lowering the risk of fracture in the bone.
Using a brace can help ease pain by averting malalignment of the affected bones.
If the bone pain is very severe then bisphosphate medications known as bisphosphonates are recommended, which is one of the preferred treatment options.
2.      Surgical Treatments
In a few cases, surgery may be required to treat complications of Paget’s disease including:
•         Bone fractures
•         Malalignment or deformity of bone
•         Severe arthritis
Surgical procedures suggested by your doctor may include:
Internal Fixation: This procedure is mainly used to repair fractures in bone affected by the disease. In this procedure, bone fragments are first repositioned into their normal alignment, with help of screws, wires, pins, or metal plates attached to the outside of the bone.
Osteotomy: This procedure can ease pain and repair alignment to weight-bearing joints that are affected by Paget’s disease, mainly the knee and hip. In this procedure your doctor will remove a wedge of bone near the damaged joint to help shift weight onto a healthier part of the joint. It is replaced with a metal, plastic, or ceramic device called a prosthesis. The prosthesis is designed in a way to duplicate the movement of a normal, healthy joint.
Total Joint Replacement: In some cases, total joint replacement may be needed if an enlarged bone begins to compress nerves, mainly in the spine or skull. In very rare cases of Paget’s sarcoma, surgery is used to remove tumour completely, then chemotherapy and radiation may be given.
In this disease, there is an increased blood supply to bones, where bisphosphonates are recommended for short time before surgery to lower potential blood loss.
Bones affected by Paget’s disease usually take longer time to heal than normal bones, where rehabilitation may also be needed to better the treatment outcomes.
If you develop any symptoms or pain pertaining to Paget’s disease consult your medical professional immediately.