What is Paget's Disease of Bone? Symptoms, Causes, & Treatment

Paget's disease of bone is a chronic condition where your bones grow too quickly and become enlarged, weakened, and misshapen. Think of it as your body's bone-building process going into overdrive in certain areas, creating bones that are bigger but not stronger.

This condition typically affects people over 50 and often runs in families. While it sounds concerning, many people with Paget's disease live normal, active lives with proper management and care.

What is Paget's Disease of Bone?

Paget's disease disrupts your body's normal bone renewal process. Normally, old bone tissue breaks down and gets replaced by new bone tissue in a balanced cycle.

In Paget's disease, this process speeds up dramatically in certain bones. Your body breaks down old bone too quickly and replaces it with new bone that forms too fast. This rushed bone formation creates bone tissue that's larger but weaker and more prone to problems.

The disease usually affects specific bones rather than your entire skeleton. Your pelvis, spine, skull, and leg bones are the most commonly affected areas.

What are the Symptoms of Paget's Disease?

Many people with Paget's disease don't experience any symptoms at all, especially in the early stages. When symptoms do appear, they often develop gradually and can vary depending on which bones are affected.

Here are the most common symptoms you might notice:

• Bone pain that's often described as deep, aching, or throbbing
• Joint pain near affected bones
• Increased warmth over affected bones
• Bone deformities or changes in bone shape
• Fractures that occur more easily than expected
• Headaches if your skull is affected
• Hearing loss when the skull bones are involved
• Leg bowing or changes in posture

Less common symptoms can include nerve compression, where enlarged bones press against nearby nerves, causing numbness or tingling. Some people also experience fatigue, though this is more subtle and often overlooked.

The pain from Paget's disease is typically worse at night and may not respond well to typical over-the-counter pain medications. If you're experiencing persistent bone pain, it's worth discussing with your healthcare provider.

What Causes Paget's Disease?

The exact cause of Paget's disease isn't completely understood, but researchers believe it results from a combination of genetic and environmental factors working together.

Your genes play a significant role in this condition. If you have family members with Paget's disease, you're more likely to develop it yourself. Scientists have identified several genes that increase your risk, with mutations in the SQSTM1 gene being one of the most common.

Environmental factors may also trigger the disease in people who are genetically predisposed. Some researchers suspect that certain viral infections earlier in life might contribute to developing Paget's disease later on, though this connection isn't definitively proven.

Age is another important factor. The condition rarely affects people under 40 and becomes more common as you get older. Men are slightly more likely to develop Paget's disease than women.

When to See a Doctor for Paget's Disease?

You should contact your healthcare provider if you experience persistent bone pain that doesn't improve with rest or over-the-counter pain medications. This is especially important if the pain is deep, aching, and worse at night.

Other warning signs that warrant medical attention include noticeable changes in your bone shape, such as bowing of your legs or changes in your skull shape. If you're experiencing unexplained fractures or bones that break more easily than expected, this could also indicate Paget's disease.

Seek medical care if you develop hearing problems, persistent headaches, or neurological symptoms like numbness or tingling in your arms or legs. These symptoms might indicate that enlarged bones are affecting nearby nerves or other structures.

If you have a family history of Paget's disease, it's worth discussing screening with your doctor, even if you don't have symptoms. Early detection can help prevent complications and improve your long-term outcomes.

What are the Risk Factors for Paget's Disease?

Several factors can increase your likelihood of developing Paget's disease, with some being within your control and others being unchangeable aspects of who you are.

The most significant risk factors include:

• Age over 50, with risk increasing as you get older
• Family history of the condition
• Being of Northern European descent
• Male gender, though the difference is small
• Living in certain geographic areas where the disease is more common

Having these risk factors doesn't mean you'll definitely develop Paget's disease. Many people with multiple risk factors never develop the condition, while others with few risk factors do.

Geographic location seems to play a role, with higher rates found in England, Scotland, Australia, and New Zealand. Interestingly, the disease is quite rare in Asia and Africa, suggesting both genetic and environmental influences.

What are the Possible Complications of Paget's Disease?

While many people with Paget's disease live without serious problems, the condition can sometimes lead to complications that affect your quality of life and overall health.

The most common complications you might encounter include:

• Fractures, especially in weight-bearing bones like your thighbone
• Arthritis in joints near affected bones
• Bone deformities that can affect your mobility
• Hearing loss if skull bones are involved
• Nervous system problems from bone pressing on nerves
• Heart problems due to increased blood flow to affected bones

Rare but serious complications can include bone cancer, though this occurs in less than 1% of people with Paget's disease. Kidney stones may also develop due to increased calcium in your blood from rapid bone breakdown.

The good news is that proper treatment can significantly reduce your risk of developing these complications. Regular monitoring and appropriate medication can help keep your bones healthy and prevent many of these problems from occurring.

How is Paget's Disease Diagnosed?

Diagnosing Paget's disease often starts with your doctor reviewing your symptoms and medical history, followed by a physical examination to check for bone tenderness or deformities.

Blood tests are usually the first diagnostic step. Your doctor will check your alkaline phosphatase levels, which are often elevated in Paget's disease. This enzyme increases when your bones are breaking down and rebuilding rapidly.

X-rays provide crucial information about your bone structure and can show the characteristic changes of Paget's disease. These images reveal enlarged bones, areas of increased bone density, and the distinctive "cotton wool" appearance that doctors look for.

A bone scan might be recommended to identify all affected areas throughout your skeleton. This test involves injecting a small amount of radioactive material that collects in areas of active bone formation, helping your doctor see the full extent of the disease.

In some cases, your doctor might order a CT scan or MRI for more detailed images, especially if complications are suspected. These tests can show how the disease is affecting nearby joints, nerves, or other structures.

What is the Treatment for Paget's Disease?

Treatment for Paget's disease aims to control your symptoms, prevent complications, and slow down the abnormal bone remodeling process. The good news is that effective treatments are available.

Medications called bisphosphonates are the primary treatment for Paget's disease. These drugs work by slowing down the bone breakdown process, allowing your bones to form more normally. Common bisphosphonates include alendronate, risedronate, and zoledronic acid.

Your doctor will choose the best medication based on your specific situation. Some bisphosphonates are taken as pills, while others are given as injections. The injection forms are often preferred because they're more convenient and may be more effective.

Pain management is another important aspect of treatment. Your doctor might recommend specific pain medications or anti-inflammatory drugs to help control your discomfort. Physical therapy can also help maintain your mobility and strength.

In rare cases where complications develop, surgery might be necessary. This could include joint replacement for severe arthritis or procedures to correct bone deformities that affect your function.

How to Take Care of Yourself at Home with Paget's Disease?

Managing Paget's disease at home involves making lifestyle choices that support your bone health and overall well-being. Small changes in your daily routine can make a meaningful difference in how you feel.

Staying active is crucial for maintaining your bone strength and mobility. Low-impact exercises like walking, swimming, or cycling can help keep your bones and joints healthy without putting too much stress on affected areas.

Nutrition plays a vital role in bone health. Make sure you're getting enough calcium and vitamin D through your diet or supplements. Foods rich in calcium include dairy products, leafy greens, and fortified foods.

Heat therapy can help manage pain and stiffness. Try warm baths, heating pads, or warm compresses on painful areas. Some people find that alternating heat and cold provides the best relief.

Create a safe environment at home to prevent falls and fractures. Remove loose rugs, ensure good lighting, and install grab bars in bathrooms if needed. Since bones affected by Paget's disease are more prone to fractures, preventing falls becomes especially important.

How Should You Prepare for Your Doctor Appointment?

Preparing for your appointment can help ensure you get the most out of your time with your healthcare provider and receive the best possible care for your condition.

Write down all your symptoms, including when they started, what makes them better or worse, and how they affect your daily activities. Be specific about your pain levels and any changes you've noticed in your bones or mobility.

Bring a complete list of all medications you're taking, including over-the-counter drugs, supplements, and vitamins. This information helps your doctor avoid potential interactions and understand what treatments you've already tried.

Gather your family medical history, especially any relatives who have had Paget's disease or other bone conditions. This information can be crucial for your diagnosis and treatment planning.

Prepare a list of questions you want to ask. Consider asking about treatment options, potential side effects, lifestyle modifications, and what to expect in the future. Don't hesitate to ask for clarification if something isn't clear.

Bring a trusted friend or family member if possible. They can help you remember important information and provide emotional support during your appointment.

What's the Key Takeaway About Paget's Disease?

Paget's disease of bone is a manageable condition that affects how your bones grow and rebuild themselves. While it can cause pain and complications, effective treatments are available to help you maintain a good quality of life.

The most important thing to remember is that early diagnosis and treatment can prevent many of the serious complications associated with this condition. If you're experiencing persistent bone pain or have a family history of Paget's disease, don't hesitate to discuss it with your healthcare provider.

With proper medical care, lifestyle modifications, and regular monitoring, most people with Paget's disease can continue to live active, fulfilling lives. The key is working closely with your healthcare team to find the treatment approach that works best for you.