Paget’s Disease (PD)
Paget’s Disease (PD) of Bone
Paget’s disease (PD) of bone is a chronic disorder characterized by abnormal bone remodeling, where bone breakdown and formation become unbalanced. This leads to bones that are larger, misshapen, weaker, and more prone to fractures than normal.
Overview
- The disease usually affects one or a few bones rather than the entire skeleton.
- Commonly affected bones include the pelvis, skull, spine, femur, and tibia.
- The remodeling process is disrupted: initially, excessive bone resorption occurs, followed by rapid but disorganized bone formation, resulting in structurally abnormal bone.
Symptoms
Many people with Paget’s disease have no symptoms and are diagnosed incidentally during imaging or blood tests. When symptoms occur, they may include:
- Bone pain: The most common symptom, often dull, aching, and worse at night.
- Misshapen bones: Enlarged skull, bowing of limbs, or curvature of the spine.
- Fractures: Bones become brittle and break more easily.
- Joint problems: Arthritis due to damage to cartilage near affected bones.
- Neurological symptoms: Tingling, numbness, or weakness if enlarged bones compress nerves (e.g., spinal nerves).
- Hearing loss or headaches: When the skull is involved.
- Warmth over affected bones: Due to increased blood flow.
- Other complications: Loosening of teeth if facial bones are affected, rarely bone cancer, and in severe cases, heart failure due to increased cardiac workload.
Causes and Risk Factors
- The exact cause is unknown.
- Genetic predisposition plays a role; the disease may run in families.
- Environmental factors, including possible viral infections, have been suggested.
- More common in older adults and people of Northern European descent.
Diagnosis
- Imaging (X-rays, bone scans) showing characteristic bone changes.
- Elevated serum alkaline phosphatase indicating increased bone turnover.
- Symptoms and physical examination findings support diagnosis.
Treatment
- Medications: Bisphosphonates are the mainstay to slow bone turnover and relieve symptoms.
- Pain management: Analgesics for bone pain.
- Surgery: For fractures, severe deformities, or joint replacements if arthritis is advanced.
- Monitoring: Regular follow-up to assess disease activity and complications.
Summary Table
| Feature | Details |
|---|---|
| Definition | Chronic disorder causing abnormal bone remodeling with enlarged, weak, misshapen bones |
| Commonly Affected Bones | Pelvis, skull, spine, femur, tibia |
| Symptoms | Bone pain, deformities, fractures, arthritis, neurological symptoms, hearing loss |
| Causes | Unknown; genetic and environmental factors |
| Diagnosis | Imaging, elevated alkaline phosphatase, clinical features |
| Treatment | Bisphosphonates, pain relief, surgery for complications |
| Complications | Fractures, arthritis, nerve compression, hearing loss, rare bone cancer, heart failure |
Consult with Our Team of Experts Now!
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Consult with Our Team of Experts Now!
References
- A comprehensive, evidence-based clinical guideline for the diagnosis and management of Paget’s disease of bone—including recommendations on imaging, biochemical testing, bisphosphonate therapy, and surgical indications—is provided in “Diagnosis and Management of Paget’s Disease of Bone in Adults: A Clinical Guideline” (DOI: 10.1002/jbmr.3657)
Paget’s disease of bone is a progressive condition that can cause significant skeletal deformities and complications if untreated. Early diagnosis and appropriate treatment help manage symptoms and improve quality of life.
