Paget's Disease of Bone

What is Paget's disease of bone?

Paget's disease is a disorder that causes enlarged and deformed bones. It occurs most commonly in the spine, skull, pelvis, thighs, and lower legs. Bone breaks down and grows rapidly, which can cause the bone to weaken. This can cause bone pain, arthritis, deformities, and fractures.

How does it occur?

The cause of Paget's disease is unknown. Paget's disease may be caused by a slow virus infection that you have for many years before symptoms appear. You are at greater risk if you have a family member who has had the disease.


Paget's disease is usually diagnosed in people over 40 years of age. It becomes more common as people get older. It is more common in the northern United States than in the rest of the US. Men and women are affected equally.

What are the symptoms?

If you have a mild case, you may not know you have Paget's disease because you may have no symptoms. Sometimes symptoms may be confused with those of arthritis or other disorders. Bone pain is the most common symptom. It often hurts most in areas near the joints. The pain is generally worse at night. You may have joint pain or stiffness if there is damage to the cartilage of your joints. This may lead to arthritis.


When Paget's disease affects your skull or spine, it puts pressure on nerves, which can cause headaches, hearing loss, neck pain, or blindness.


Increased head size, bowing of the legs, or curvature of the spine may occur in advanced cases. Fractures may happen without warning or be caused by accidents. Healing is difficult because the bones are weak.

How is it diagnosed?

Tests that help diagnose Paget's disease include:

  • Your health care provider will ask about your symptoms and examine you.
  • An x-ray, CT scan, or MRI scan will show increased bone density, thickening, bowing, and overgrowth.
  • An alkaline phosphatase blood test checks for high levels of alkaline phosphatase, which may indicate Paget's disease.
  • If the skull is involved, vision and hearing testing may also be done.

How is it treated?

The goal of treatment is to control pain, avoid complications, relieve nerve compression, and keep bones from becoming deformed.


Currently, several kinds of medicines are used to control the activity of Paget's disease. These include:

  • alendronate (Fosamax)
  • etidronate (Didronel)
  • gallium nitrate (Ganite)
  • intranasal calcitonin-salmon (Miacalcin, Calcimar)
  • pamidronate (Aredia)
  • plicamycin (Mithracin)
  • risedronate (Actonel)
  • tiludronate (Skelid).

Analgesics (painkillers) or nonsteroidal anti-inflammatory drugs (NSAIDS) may be prescribed for pain.


You may need orthopedic surgery. Surgery can help fractures to heal properly. If you are severely disabled by the disease and medicines and physical therapy are no longer helpful, your health care provider may recommend joint replacement of the hips or knees. Cutting and realignment of pagetic bone (osteotomy) may help painful weight-bearing joints, especially the knees.


People with Paget's disease are more likely to have kidney stones. To help prevent kidney stones, make sure that you drink plenty of water every day.


Exercise is very important in keeping your bones healthy, your weight under control, and your joints flexible. You should avoid putting stress on the injured bones. Discuss any exercise program with your health care provider before you begin.

How long will the effects last?

The outlook is generally good, especially if you start treatment before you have major changes in your bones. Symptoms progress slowly, and the disease generally does not spread to normal bones.


Treatment can control Paget's disease and lessen symptoms, but it is not a cure.


Paget's disease may lead to other medical conditions, including:

  • arthritis
  • hearing loss
  • heart valve problems
  • high blood pressure
  • high levels of calcium in the blood
  • irregular heartbeat
  • kidney stones
  • loosened teeth
  • loss of vision
  • nervous system problems
  • sarcoma (bone cancer).

How can I take care of myself?

There is no way to prevent Paget's disease of the bone. Early diagnosis and treatment is important. If someone in your family has Paget's disease, and you are over 40 years old, have an alkaline phosphatase blood test every 2 or 3 years.


Home care measures that may help relieve symptoms include:

  • applying heat to relieve pain
  • sleeping on a firm bed
  • accident proofing your home to prevent falling, or injury
  • maintaining a healthy weight
  • maintaining a healthy diet
  • exercising with the guidance of your health care provider.

For more information, contact:


Paget Foundation
120 Wall St., Suite 1602
New York, NY 10005-4001
800-23-PAGET
212-509-5335
Web site: http://www.paget.org


Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.


HIA File BJM3221F.HTM Release 9.0/2006

Copyright © 2006 McKesson Corporation and/or one of its subsidiaries. All Rights Reserved.

Copyright © 2006 McKesson Corporation and/or one of its subsidiaries. All Rights Reserved.