Paget's disease of bone

Paget's disease is a problem of abnormal bone growth. It may affect just one bone, but it usually affects more than one.

• In normal bone, the bone tissue is constantly being broken down, absorbed into the body, and then rebuilt with new cells.
• In Paget's disease, bone tissue is broken down and absorbed much faster than normal, so the body speeds up the bone rebuilding process. But this new bone is often weak and brittle, and it breaks easily.

Paget's disease is most common in people older than 50, and the risk of getting it increases with age. Most people who have it are able to lead normal lives.

Most people with Paget's disease have no symptoms. When symptoms occur, the most common ones are:

• Bone pain. It may be worse at night and get better with exercise. People often mistake the pain for normal aging or arthritis.
• Deformed bones, such as bowed legs, an enlarged skull or hips, or a curved backbone.
• Broken bones, or fractures.

Other symptoms may occur, depending on which part of the body is affected by Paget's disease.

• If it affects the skull, you may have symptoms such as headaches, sagging face muscles (facial droop), hearing problems, or loose teeth.
• If it affects the spine, it may damage nerves and cause leg pain, numbness, or weakness. It can also cause an emergency condition called cauda equina syndrome that results in loss of feeling in the pelvic area and legs.

Paget's disease is most often found by chance when a person sees a doctor for a problem such as hip or back pain. An abnormal X-ray or blood test may lead the doctor to discover this disease.

To diagnose Paget's disease, the doctor will ask about your past health, do a physical exam, and order tests such as:

Bone X-rays.

Affected bones often look deformed and too thick on X-rays.

Bone scan.

This is the best test for diagnosing Paget's disease. You may have a bone scan of your whole body to find out which bones are affected.

Blood and urine tests.

The most important one for diagnosing Paget's disease is a blood test for alkaline phosphatase, an enzyme made by bone. If the level of this enzyme is high, your doctor will want to do other tests.

You might also need other tests, such as an MRI or a CT scan.

You may not need treatment. But you will need regular doctor visits to watch for problems from the disease, such as arthritis. If you need treatment, your doctor may prescribe medicine to reduce bone loss and control symptoms. You might also need other treatments, such as over-the-counter pain relievers, physical therapy, or splints.

There are many things you can do to help yourself when you have Paget's disease.

• Learn ways to manage your pain. For example, you might keep a pain diary to find out what makes your pain better or worse.
• Take care to avoid falls. For example, keep your home's walkways free of clutter and electric cords. Put grab bars in your bathroom.
• Do weight-bearing exercise to keep your bones strong. Walking, dancing, or lifting weights may be good, but make sure that you don't put stress on affected bones. Your doctor or physical therapist can suggest exercises for you.
• Eat a healthy diet that includes plenty of calcium and vitamin D. You need both to build strong bones.