Many of us are aware of osteoporosis, but not everyone is as well-informed about Paget’s disease of the bone. This is a long-term condition that affects men more than women. Its incidence is greater after 50 years of age and it is often initially symptomless.
What Is Paget’s Disease?
- In normal bone tissue, a cyclic process of removal of old bone cells followed by their replacement with new bone cells takes place.
- In Paget’s disease, removal of the old bone cells is faster than normal.
- As a result, the new bone cells are also manufactured faster and hence are not properly formed – they might be malformed, weak and prone to breaking.
- While the condition can affect any bone, the most commonly affected ones are the bones of the hip, legs, skull and spine.
- It can also affect more than one bone at a time and might manifest in more than one part of the affected bone.
While the exact cause cannot be pinpointed, there are several possible triggers:
- Age: The condition is very rare in younger people – people below 40 years are not usually affected by it.
- Hereditary: It has been seen that when one person in the family is affected by it, chances of family members developing it are greater.
- Location: While it is rare in China, India and Japan, people in the United States, Europe, Australia and New Zealand seem to show a greater risk of developing it.
- The possibility of environmental factors playing a role in its incidence is inconclusive as of now.
The condition is often symptomless with its discovery being made when an x-ray or a blood test for some other purpose is done. When symptoms do manifest, the following may be observed.
- Pain that could be due to the condition itself or from something associated with it (for example, a fracture).
- The person is also more prone to fractures.
- The affected bone looks malformed.
- The joints near the affected area suffer arthritic changes.
- Loss of sensation due to nerves being impinged on.
- The condition can also elevate the calcium levels in the cells to more than what is normal. This will result in tiredness, loss of appetite, stomach ache and it might also affect bowel movements.
- In extremely rare cases, Paget’s sarcoma can occur in people over 70 years of age.
- The doctor will initially perform a physical examination followed by x-rays which will help in confirming the condition. The x-ray will typically show a bone that is bigger in size than usual and may also be deformed.
- A blood test to determine the level of alkaline phosphatase will also help with diagnosis. This level will be elevated for people with Paget’s disease.
- To find out which bones have been afflicted, a bone scan may be done. Here, a radioactive dye is injected and the absorption of the dye is checked. The affected bones will absorb more than the normal bones.
- A biopsy can also be done to aid in diagnosis.
Paget’s disease cannot be cured completely but there are many ways by which the condition’s effects and complications can be managed.
- If there are no symptoms at all, no treatment is required and the doctor will suggest a wait and watch approach.
- The doctor might want regular x-rays done to keep an eye on the condition of the bone and to pick up any early signs of the condition worsening.
- If the condition does show signs of worsening, painkillers will be given initially to handle the pain.
- If the femur is affected, using devices to assist while walking will keep pressure off the leg which will in turn help with pain reduction. This might also help avoid falls.
- Braces might be suggested to keep the bones aligned.
- Treatment with bisphosphonates:
- If the patient complains of an increase in pain, bisphosphonates will be prescribed.
- Bisphosphonates target the cells which break down the bone and thereby inhibit the process of bone resorption.
- There are various kinds of bisphosphonates and the doctor will decide which one is best for the patient taking into account the patient’s condition and other health factors. The duration for which it has to be taken will also be discussed.
When non-invasive treatment options do not help, the doctor might suggest surgery to deal with the side effects resulting from Paget’s disease. The type of surgery advocated will depend on the specifics of the patient’s condition.
- Surgery can be done to manage fractures caused by Paget’s disease. During surgery, the bones will be positioned properly and then held in place by plates, screws, etc.
- A surgical procedure called osteotomy might be done to remove a portion of the bone to transfer the weight onto stronger bones.
- The joints (near the bone affected by Paget’s disease) could be afflicted with arthritis. For these joints, joint replacement surgery might be done. In joint replacement, a portion or whole of the joint will be removed and replaced with a prosthetic.
- In the case of Paget’s sarcoma, surgery will be needed to remove the tumor followed by chemotherapy and radiation therapy.
Paget’s disease can be handled effectively with early treatment – people affected by this condition can lead normal lives. Even if complications do happen, surgery will help in the effective management of the condition.