If there is joint damage and resulting pain is a problem, joint replacement surgery may be needed. There are two types of doctors who are the most experienced in treating patients with Paget’s disease: Endocrinologists, who treat metabolic conditions. Rheumatologists, who treat arthritis and other musculoskeletal conditions.
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How is Paget's disease treated?
Medical treatments can help decrease the symptoms of Paget's disease, but there is no known way to reverse the effects on the bone. Surgery is used mainly to treat the complications of Paget's disease. You may need surgery if you have a fracture, if your bone is badly aligned, or if severe arthritis develops.
What kind of doctor should I See for progressive Paget's disease?
Paget's disease patients can also present to the rheumatologist, orthopaedic surgeon or ENT specialist with symptoms specifically related to the disease, such as bone pain, bone deformity, fracture and deafness.
Can Paget's disease affect the entire bone?
It can be present in just one bone or in several bones. It can affect the entire bone or just part of it. Figure 3: Paget's disease of the spine. The white, patchy appearance of the bone on this X-ray is characteristic of the dense but disordered bone in this disease. Figure 4: Paget's disease of the pelvis. The bone is thick, wide and patchy.
What is bone remodeling in Paget's disease?
Bone Remodeling. In Paget's disease, osteoclasts are more active than osteoblasts. This means that there is more bone absorption than normal. The osteoblasts try to keep up by making new bone, but they overreact and make excess bone that is abnormally large, deformed, and fits together haphazardly.
What specialist manages Paget's disease?
Paget's disease can affect many parts of the body. You may need to see more than one type of doctor, including: Endocrinologists, who treat hormonal and metabolic disorders. Rheumatologists, who treat joint and muscle disorders.
Which is the first-line treatment for Paget's disease?
Bisphosphonates are first-line therapy for Paget's disease, and the advent of the new bisphosphonates permits a dramatic improvement in treatment.
Is Paget's disease of the bone an autoimmune disease?
Paget's disease of bone is a chronic autoimmune inflammatory disease that leads to an increase in bone reabsorption. While depression is extensively described in Paget's disease, affecting up to 50% of patients, the prevalence of manic episodes is unknown.
What happens to bones in Paget's disease?
Paget's (PAJ-its) disease of bone interferes with your body's normal recycling process, in which new bone tissue gradually replaces old bone tissue. Over time, bones can become fragile and misshapen. The pelvis, skull, spine and legs are most commonly affected.
Is Paget's disease serious?
Paget's disease of bone can sometimes lead to further, potentially serious problems. These include: fragile bones that break more easily than normal. enlarged or misshapen bones.
What are the three phases of Paget's disease?
The key histopathological feature of Paget disease involveS the bone architecture and includes the three phases of the disease: mixed, osteolytic, and osteosclerotic. These phases may occur at the same time or separately.
What is the best treatment for Paget's disease?
Osteoporosis drugs (bisphosphonates) are the most common treatment for Paget's disease of bone. Bisphosphonates are typically given by injection into a vein, but they can also be taken by mouth. When taken orally, bisphosphonates are generally well tolerated but can irritate the stomach.
What is the life expectancy of someone with Paget's disease?
If treatment occurs before major changes in bone occur, the majority of patients with Paget's disease are able to live a normal, active life. When complications do develop, surgical treatment is usually effective in relieving pain and improving function.
Does Paget's disease cause fatigue?
This rare complication might cause fatigue, weakness, loss of appetite, abdominal pain, or constipation. A doctor can also detect Paget's disease from its effect on the heart if excess blood supply is shunted to overactive bones in severe cases.
Can Paget's disease of bone be cured?
There's currently no cure for Paget's disease of bone, but treatment can help relieve the symptoms. If you do not have any symptoms, your doctor may suggest keeping an eye on your condition and delaying treatment until any problems occur.
Which of the following is helpful in the diagnosis of Paget's disease?
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.
Does Paget's disease spread?
Most women with Paget's disease of the breast have an underlying malignancy, which may be completely contained within the milk ducts (ductal carcinoma in situ) or may have invaded the surrounding tissue, potentially spreading to the lymph nodes under the arms (axillary lymph nodes) and other regions of the body ( ...
What is a rheumatologist?
A rheumatologist is an internal medicine physician with subspecialized training in rheumatology. This medical specialty deals with musculoskeletal conditions, as well as autoimmune and inflammatory conditions in people of all ages. Many of these conditions may run in families.
What does a rheumatologist do?
Rheumatologists diagnose, treat and manage a broad range of conditions, including:
What is the difference between a rheumatologist vs. an orthopaedist?
Orthopaedists and rheumatologists specialize in conditions affecting the joints, bones, muscles, ligaments and tendons. They treat many of the same conditions, including joint pain and tendinitis. But there are a few differences between these medical specialties.
What type of medical training do rheumatologists undergo?
Training starts with a traditional undergraduate bachelor’s degree followed by a four-year medical school curriculum (a doctor of medicine degree, or MD) or osteopathic education (a doctor of osteopathy degree, or DO). Osteopathic doctors learn a holistic approach that considers a person’s mind, body and spirit.
What are reasons to see a rheumatologist?
One reason is a family history of rheumatic or autoimmune disease. You may also make an appointment if you have symptoms of a condition they treat. It’s especially important for symptoms that come on suddenly or worsen quickly.
How soon should I see a rheumatologist?
It’s important not to delay seeking care. Some rheumatic diseases, like arthritis, can cause permanent joint damage. Receiving care in earlier stages lowers your risk.
How do I prepare for an appointment with a rheumatologist?
If you are a new patient, it may be a few weeks before you can get an appointment. During this time, there are steps you can take to prepare. These include:
Why do you need surgery for Paget's disease?
Surgery is primarily used to treat the complications of Paget's disease. You may need surgery if you have a fracture, badly aligned bone, or severe arthritis. You may also need surgery if enlarged bone compresses nerves, especially in the spine or skull.
What is the end result of Paget's disease?
The end result is bones that are large and dense, but weak and brittle. The bone is prone to fractures, bowing and deformities. ...
How do you know if you have Paget's disease?
People with Paget's disease often experience no symptoms at all. A doctor may notice Paget's disease on an X-ray that is taken for another reason or during routine blood work when an elevated serum alkaline phosphatase level is found. For patients who do have symptoms, bone pain is the most common complaint. This pain can be related to active Paget's disease or its complications which include: 1 Fractures of brittle bone 2 Deformity of bone 3 Advanced arthritis of joints near affected bone 4 Loss of sensation or movement caused by compression of nerves near enlarged bones
What is the process of reforming bone?
It is slightly more common in men, than women. In normal bone, a process called remodeling takes place every day. Bone is absorbed and then reformed in response to the normal stresses on the skeleton. Osteoclasts are the cells of the bone that absorb bone. Osteoblasts are the cells of the bone that make new bone.
How old is too old to get Paget's sarcoma?
Paget's sarcoma occurs in only about 1 percent of patients with Paget's disease. These patients are usually older than 70 years of age. This type of malignant bone tumor is very aggressive and carries a poor prognosis.
What does Paget's disease look like?
In the very early stages of Paget's disease, when there is just overactive absorption going on, it can look like there is a hole in the bone. Later in the disease process, this darker area can take the shape of a V, with denser, thicker bone following behind it.
What is the treatment for Paget's sarcoma?
In the rare cases of Paget's sarcoma, surgery is almost always used to try to remove the tumor entirely. Chemotherapy and radiation therapy may also be used. Research on the Horizon. Scientists are currently investigating the genes that may be involved with Paget's disease.
How to diagnose Paget's disease?
X-rays. X-rays provide images of dense structures, such as bone. Paget’s disease can usually be diagnosed by looking at an x-ray. A bone affected by Paget’s usually appears larger and denser than a normal bone. It may also have a deformed shape.
What is Paget's disease?
Paget's disease of bone is a chronic disease of the skeleton. In healthy bone, a process called remodeling removes old pieces of bone and replaces them with new, fresh bone. Paget’s disease causes this process to shift out of balance, resulting in new bone that is abnormally shaped, weak, and brittle. Paget’s disease most often affects older ...
Why do doctors remove wedges of bone?
During the procedure, your doctor will remove a wedge of bone near the damaged joint in order to shift weight onto a healthier part of the joint. Illustrations show a tibial osteotomy to straighten a bowed leg. (Left) A wedge of bone is removed to straighten out the leg.
How old is too old to get Paget's sarcoma?
Paget's sarcoma occurs in only about 1 percent of patients with Paget's disease. These patients are usually older than 70 years of age. This type of malignant bone tumor is very aggressive and has a poor prognosis.
Which bone cell is more active in Paget's disease?
More specifically: Cells of the bone called "osteoclasts" absorb bone. Cells of the bone called "osteoblasts" make new bone. In Paget's disease, osteoclasts are more active than osteoblasts. This means that there is more bone absorption than normal.
What is the end result of Paget's disease?
The end result is bones that are large and dense, but weak and brittle. The bone is prone to fractures, bowing, and deformities.
Where does Paget's disease appear?
Paget's disease can affect any bone in the skeleton. It appears most often in the spine, pelvis, long bones of the limbs, and skull. It can be present in just one bone or in several bones. It can affect the entire bone or just part of it.
What is the best treatment for Paget's disease?
Osteoporosis drugs (bisphosphonates) are the most common treatment for Paget's disease of bone. Bisphosphonates are typically given by injection into a vein, but they can also be taken by mouth. When taken orally, bisphosphonates are generally well tolerated but can irritate the stomach.
What test can you do for Paget's disease?
Lab tests. People who have Paget's disease of bone usually have elevated levels of alkaline phosphatase in their blood, which can be revealed by a blood test.
What tests can be done to confirm Paget's disease?
During the physical exam, your doctor will examine areas of your body that are causing you pain. He or she may also order X-rays and blood tests that can help confirm the diagnosis of Paget's disease of bone.
Can you get Paget's disease of bone?
Most people with Paget's disease of bone don't have any symptoms and are diagnosed when an X-ray or blood test taken for another reason reveals signs of Paget's disease of bone. In some cases, you may be referred to a doctor who specializes in metabolic and hormonal disorders (endocrinologist) or in joint and muscle disorders (rheumatologist).
Do you need treatment for a symtom?
If you don't have symptoms, you might not need treatment. However, if the disease is active — indicated by an elevated alkaline phosphatase level — and is affecting high-risk sites in your body, such as your skull or spine, your doctor might recommend treatment to prevent complications, even if you don't have symptoms.
Does Risedronate cause bone pain?
Risedronate (Actonel, Atelvia) Rarely, bisphosphonate therapy has been linked to severe muscle, joint or bone pain, which might not resolve when the medication is discontinued. Bisphosphonates can also increase the risk of a rare condition in which a section of jawbone dies and deteriorates, usually associated with active dental disease ...
What is the treatment for Paget's disease?
Many patients also require therapy with analgesics and anti-inflammatory agents, since pain in Paget's disease can arise not only from increased bone turnover but also from complications such as osteoarthritis and nerve compression syndromes, which do not respond well to antiresorptive therapy .
What is Paget's disease?
Paget's disease of bone is a common condition with a strong genetic component, characterized by focal increases in bone turnover, affecting one or more bones throughout the skeleton. Paget's disease can be asymptomatic but is frequently associated with bone pain, bone deformity, pathological fracture, secondary osteoarthritis and deafness. Inhibitors of osteoclastic bone resorption, such as bisphosphonates and calcitonin, suppress bone turnover and improve bone pain in Paget's disease. Many patients also require therapy with analgesics and anti-inflammatory agents, since pain in Paget's disease can arise not only from increased bone turnover but also from complications such as osteoarthritis and nerve compression syndromes, which do not respond well to antiresorptive therapy. Comparative studies have shown that second- and third-generation bisphosphonates, such as tiludronate, alendronate and risedronate, are more effective than etidronate at inhibiting bone turnover in Paget's disease but they have not been found to be significantly more effective in controlling bone pain. Importantly, none of the treatments that are currently available for Paget's disease have been shown to prevent complications such as deafness, fracture or bone deformity, or to alter the natural history of the disease. More research is required to define the long-term effects of antiresorptive treatment on clinical outcomes in Paget's disease, so that clinicians and their patients can make better-informed choices about the risks and benefits of treatment.
What bisphosphonates are used for Paget's disease?
Four bisphosphonates are currently licensed for treatment of PDB in the UK. These are etidronate, pamidronate, tiludronate and risedronate. Clodronate, alendronate and ibandronate have been used in the treatment of PDB, but they are not marketed for the treatment of Paget's disease within the UK.
What is the most widely used antiresorptive agent for the treatment of Paget's disease?
Bisphosphonates are the most widely used antiresorptive agents for the treatment of Paget's disease. They have in common a core structure of phosphorous–carbon–phosphorous atoms, to which is attached various chemical side-chains.
What is the role of bisphosphonate in bone pain?
Bisphosphonates are thought to improve bone pain in Paget's disease by inhibiting bone turnover.
Does Paget's disease cause deafness?
Importantly, none of the treatments that are currently available for Paget's disease have been shown to prevent complications such as deafness, fracture or bone deformity, or to alter the natural history of the disease.
Is Paget's disease a slow virus?
The aetiology of Paget's disease continues to be a subject of debate. There is evidence to suggest that PDB might be caused by a slow-virus infection of osteoclasts, but this remains controversial, with positive results in some studies and negative results in others [ 5–7 ].
Why do you need surgery for Paget's disease?
Surgery is used mainly to treat the complications of Paget's disease. You may need surgery if you have a fracture, if your bone is badly aligned , or if severe arthritis develops . You may also need surgery if the enlarged bone begins to compress nerves, especially in the spine or skull.
What is the best treatment for Paget's disease?
When bone pain is more significant, medications called bisphosphonates are the treatment of choice. These drugs block osteoclasts and can be very effective in treating Paget's disease. There are several types of bisphosphonates that are taken by mouth (oral form) or by injection (intravenous form).
How old is too old to get Paget's sarcoma?
Paget's sarcoma (Figure 6) occurs in only about 1 percent of patients with Paget's disease. These patients are usually older than 70 years of age. This type of malignant bone tumor is very aggressive and carries a poor prognosis.
How to diagnose Paget's disease?
A doctor can also detect Paget's disease with urine tests that show rapid bone turnover.A doctor can usually diagnose Paget's disease by looking at an X-ray. An affected bone appears larger and more dense than usual. It can have a deformed shape.
What is Paget's disease?
Paget's disease of bone is a chronic disease of the skeleton. It is a common disease in older people, occurring in about 3 percent to 4 percent of the population over age 50. It is slightly more common in men than women. In normal bone, a process called remodeling takes place every day. Bone is absorbed and then reformed in response to ...
Where does Paget's disease appear in the skeleton?
Paget's disease can affect any bone in the skeleton. It appears most often in the spine (Figure 3), pelvis (Figure 4), long bones of the limbs (Figure 5) and skull. It can be present in just one bone or in several bones.
Where does Paget's disease occur?
It is also more common in people of Anglo-Saxon descent and those who live in certain geographic areas, such as England, the United States, Australia, New Zealand and Western Europe. It is not common in Scandinavia, China, Japan or India.Some doctors suggest that some environmental exposure, not just genetics, is important in the development of Paget's disease. This has not been proven definitively.
What are the symptoms of Paget disease?
These are the most common symptoms of Paget disease of the bone: Arthritis. Bone deformity. Pain. Risk for bone fractures. Very rarely, Paget disease may progress to bone cancer. The symptoms of Paget disease of the bone may look like other bone disorders or medical problems. Always talk with your healthcare provider for a diagnosis.
What causes a bone to become enlarged and deformed?
Key points about Paget disease . Paget disease of the bone is a chronic bone disorder. It causes bones to become enlarged and deformed. It may be caused by a slow viral infection of bone. Genes may play a role. Symptoms may include: