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What is Paget’s disease of bone, and how is it managed?

What is Paget’s Disease of Bone?

Paget’s disease of bone, also known as osteitis deformans, is a chronic condition characterized by abnormal bone remodeling. In healthy bones, a constant process of resorption (breaking down old bone) and formation (building new bone) maintains bone health. However, in Paget’s disease, this process becomes unbalanced, leading to excessive and disorganized bone formation. This results in bones that are:

  • Enlarged and thickened: Affected bones appear larger and denser than normal bones.
  • Weakened and brittle: Despite the increased density, the new bone formed in Paget’s disease is structurally weaker and more prone to fractures.
  • Deformed: The disorganized bone growth can lead to bones becoming misshapen, causing pain and mobility problems.

Causes and Risk Factors of Paget’s Disease

The exact cause of Paget’s disease is unknown, but it is believed to involve a combination of genetic and environmental factors. A specific gene mutation has been identified in some people with Paget’s disease, but it is not clear how this mutation interacts with environmental factors to trigger the disease.

Certain risk factors increase the likelihood of developing Paget’s disease, including:

  • Age: The disease is more common in people over 50.
  • Sex: Men are slightly more likely to develop Paget’s disease than women.
  • Family history: Having a close relative with Paget’s disease increases your risk.
  • Previous bone fractures: A history of bone fractures, especially in the pelvis or spine, may be a risk factor.

Symptoms of Paget’s Disease

Many people with Paget’s disease experience no symptoms initially. However, as the disease progresses, symptoms may develop, including:

  • Bone pain: This is the most common symptom, often described as a deep, aching pain in the affected bones.
  • Bone fatigue: Bones may feel tired and achy after activity.
  • Bone deformity: Affected bones may become misshapen, leading to noticeable changes in appearance, such as a bowed spine or enlarged skull.
  • Joint pain and stiffness: If the disease affects bones near joints, it can cause pain, stiffness, and difficulty moving the joint.
  • Fractures: Bones weakened by Paget’s disease are more prone to fractures.
  • Hearing loss: If the skull is affected, it can compress the inner ear, leading to hearing loss.

Diagnosing Paget’s Disease

Diagnosing Paget’s disease usually involves a combination of tests, including:

  • Physical examination: Your doctor will ask about your symptoms and perform a physical exam to look for signs of bone deformity or tenderness.
  • X-rays: X-rays can show characteristic changes in the affected bones, such as thickening and increased blood vessel activity.
  • Bone scans: Bone scans can reveal areas of increased bone activity associated with Paget’s disease.
  • Blood tests: Blood tests can help rule out other conditions and assess the severity of Paget’s disease.

Managing Paget’s Disease

There is no cure for Paget’s disease, but treatment can help manage symptoms and prevent complications. Treatment options depend on the severity of the disease and the specific symptoms you are experiencing.

Medications:

  • Bisphosphonates: These medications are the mainstay of treatment for Paget’s disease. They slow down the abnormal bone remodeling process and can effectively reduce bone pain and prevent fractures.
  • Calcitonin: This hormone can also help reduce bone turnover and relieve pain.
  • Pain relievers: Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help manage pain.

Lifestyle changes:

  • Limiting physical activity: While staying active is important, avoiding strenuous activities that put stress on your bones is recommended.
  • Maintaining a healthy weight: Excess weight can put additional strain on your bones.
  • Preventing falls: Taking steps to prevent falls, such as using grab bars and wearing non-slip shoes, is important to protect your bones from fractures.

Surgery:

In some cases, surgery may be necessary to correct bone deformities or repair fractures.

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