Paget’s disease is the most common metabolic bone disorder in the United States, second only to osteoporosis. Yet, it often goes unrecognized and untreated until it is in an advanced stage. First described by Sir James Paget in 1877, the disease is a disorder of bone remodeling, or turnover, in which there is excessive resorption (bone failure) followed by excessive but structurally inferior new bone formation. Paget’s disease occurs in men and women fairly equally, and is more common in people over 50 years old. It affects 1.2% to 4% of Americans above the age of 50, and as many as 10% of those over 80 (Lindgren). Although Paget’s disease and osteoporosis can occur in the same patient, they are completely different disorders. Despite their marked differences, several treatments for Paget’s disease are also used to treat osteoporosis (NIH ORBD).

A good question would want to know what causes this disease to remain

As we learn from studying this disease, bone pain is the most common symptom although “Approximately 70% of patients…don’t have overt clinical symptoms. Of those who do, the symptoms vary with the location of the involved sites and the rate of bone turnover (Lindgren). “Many patients have significant bone pain and an increased risk of bone fracture” (Health & Medicine Week, 2003). The pain can be caused by the involved (pagetic) bone itself, osteoarthritis of nearby joints, nerve compression caused by increases in bone size, micro-fractures, or damage to joint cartilage. Patients often describe the pain as continuous, with increased pain occurring at rest, when bearing weight, when limbs are warm, and at night (Lindgren). With skull involvement, compression of nerves caused by osseous growth can lead to neurologic symptoms, including headaches, loss of hearing, and loss of vision. Hearing loss has long been known to be a complication of Paget's disease of bone. Older ideas about the mechanisms of hearing loss are being replaced by a new view based on experimental evidence from patients. Studies reviewed show no evidence of auditory nerve dysfunction and confirm a cochlear site of lesion. A loss of bone mineral density in the cochlear capsule is associated with both a high-tone hearing loss and a low-tone air-bone gap.

Some treatment may require surgery. There are generally three major complications of Paget’s disease for which surgery may be recommended. The first complication is fractures in bone affected with Paget’s disease. Surgical repair of fractures in bones with Paget’s disease may help the fractures heal in a better position. When needed, metal rods may stabilize the bone. The second complication is severe degenerative arthritis. If medication and physical therapy are no longer helpful and if disability is severe, joint replacement of the hips and knees may be considered. The third complication involves bone deformity, especially of the tibia. The surgical cutting and realignment of a bone with Paget’s disease may help painful weight bearing joints, especially the knees.

The FDA has approved five bisphosphonates for treatment of Paget’s disease—alendronate sodium (Fosamax), pamidronate disodium (Aredia), tiludronate disodium (Skelid), risedronate sodium (Actonel), and etidronate disodium (Didronel). An older drug, calcitonin (Calcimar, Miacalcin), also inhibits osteoclast resorption, but it is not considered as efficacious as the bisphosphonates. Calcitonin is an alternative for patients who can’t tolerate bisphosponates, which may cause esophageal irritation and gastrointestinal symptoms such as nausea, abdominal pain, and diarrhea (Lindgren).

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