Paget’s Disease

What is Paget’s Disease?

Paget’s disease is a disease of the elderly in which bone breaks down and is not replaced properly by the body. This leads to weaker bones and bone pain.

Who is at risk for Paget’s Disease?

The cause remains unknown, but it is believed to be a genetic disease, so having a family history of the condition makes one more at risk of developing it. Men over 40 are at increased risk and people of European descent are more likely to develop Paget’s.

What are the symptoms of Paget’s Disease?

More than 70% of patients are asymptomatic and the condition is discovered through routine bloodwork which shows an elevated alkaline phosphate level. In patients who are symptomatic bone pain is the most common symptom, specifically in the spine, pelvis, skull, and legs. Paget’s can also present with skull enlargement leading to deafness when bone compresses the 8th cranial nerve. 

How is Paget’s Disease treated?

Bisphosphonates are the first-line treatment. IV bisphosphonates include zoledronate and pamidronate. Oral bisphosphonates include alendronate and risedronate. Bisphosphonates work by decreasing bone turnover. NSAIDs can be used to help control bone pain. Calcium and vitamin D supplementation can also be given. 

Side effects of Bisphosphonates include esophagitis, so it is important to stay upright for 30 minutes following. Rarely atypical femur fractures and osteonecrosis of the jaw can be caused by bisphosphonate use.

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