Our bones provide support to our bodies, amongst other functions. Without them, we would probably be formless creatures like something out of a horror movie.
These bones wear out over time and need to be regenerated to replace the old bones even after we have reached our full height. Cells known as osteoblasts and osteoclasts are responsible for creating new bone material.
However, this process of regeneration can sometimes be hastened, causing irregular bone formations. This condition is known as Paget’s disease.
Paget’s disease of the bone, also known as Osteitis deformans, is a condition characterized by excessive resorption of old bone, which is followed by the formation of abnormal new bones.
It is the second most common type of bone disorder after osteoporosis. Bone regeneration removes old, worn-out bones and replaces them with fresh bone. Paget’s disease, however, impairs this process, which results in abnormally shaped, fragile, and brittle new bones.
According to the American Academy of Orthopaedic Surgeons, this disorder is estimated to affect about 2-3 percent of the population over 55. These changes to the bone structure may result in pain, fracture, deformity, or arthritis of the affected joints.
There is no known cause for the disorder, although it has been attributed to be caused by genetic factors. The bones commonly affected by the disease include femur, tibia, pelvis, spine, and skull.
It can affect a single bone or multiple bones but never the entire skeleton. The disease does not spread from one bone to another, and it rarely develops into cancer of the bone.
There is no cure for the disease but can be treated with different medications such as calcitonin and bisphosphonates to reduce the pain and control the disorder. The disease affects mostly white people and is most common in the United Kingdom.
It can, however, affect any race. Men are more affected by Paget’s disease than women. Paget’s disease was named in 1877 by the English Surgeon Sir James Paget.
Causes and Risk Factors of Paget’s Disease
The cause of this disorder has been yet to be established, although genetic and environmental factors have been suggested to be the cause. The disease tends to run in families.
According to the American College of Rheumatology, a relative would have the condition in about 20-30% of the cases.
Age also increases one’s risk of developing the disease, although it rarely occurs in people under the age of 40.
It is also common in people of Anglo-Saxon descent and those that live in certain regions such as New Zealand, England, the United States, and Western Europe.
It has been theorized that Paget’s disease may be caused by a viral illness early in life, but this claim has not yet been established.
Signs and Symptoms of Paget’s Disease
Many people with the disease are asymptomatic. This means that they do not show any symptoms of the disorder. When symptoms do show, they may be mistaken for other bone diseases like arthritis.
Common symptoms of the disease include tenderness, swelling of joints, joint pain, or redness of the skin on bones affected by the disease. The symptoms also depend on which bone is affected.
It can cause severe pain in the hips if the pelvis is affected. Overgrowth of bone in the skull can cause hearing loss. Compressed nerve roots which can lead to pain or numbness in the arm or leg can occur if the spine is affected.
Bow-leggedness can occur as a result of Paget’s disease in the legs. Some people may not notice the disease until after experiencing a fracture in the affected bone, which takes longer to heal.
Other health conditions that can be caused by Paget’s disease include:
Diagnosis of Paget’s Disease
Diagnosis of this disorder is performed by a medical profession via physical examination to identify the possibility of Paget’s disease and to rule out other possible bone problems that may cause abnormalities or deformities.
Bone scans and laboratory tests would then be used to determine the severity of the condition. Paget’s disease can be indicated using an alkaline phosphatase blood test.
People with the disease often have an elevated level of alkaline phosphatase in their blood. This increased level of alkaline phosphatase may, however, be caused by other diseases or conditions.
Paget’s disease can be confirmed by using bone scans, which can reveal the extent of the condition and abnormalities, including areas where bone deposition has increased or decreased. This can be achieved using x-rays.
Treatment of Paget’s Disease
Paget’s disease has no cure. But there are treatment options available to reduce the severity of the symptoms. Many people living with the disease would not require treatment as they are mostly asymptomatic.
Treatment would be needed if necessary. Bisphosphonates would be prescribed as well as vitamin D and calcium supplements. Biophosphates would help to reduce the breakdown of diseased bone.
According to the office of Dietary Supplements (ODS), it is recommended that people should consume at least 600 IU (International Units) of vitamin D and 1,200 milligrams (mg) of calcium a day between the ages of 51-70 years.
The ODS recommends that people above 70 years of age should increase their vitamin D intake to 800 IU a day. Doctors also recommend more exposure to sunlight as it increases the body’s absorption of vitamin D.
Surgery may also be necessary if the disease involves bone deformity or a fracture in the bone. These fractures commonly occur in the shinbone and thighbone.
Paget’s disease cannot be prevented for most people. Still, regular exercising can help to maintain optimum skeletal health, maintain mobility of the joints.
Patients with Paget’s disease should consult their doctor before engaging in any exercise program as the symptoms can exacerbate if extra stress is placed on the bones affected by the disease.