Paget’s Disease
...of arthritis. As the disease progresses, bone and joint pain develop. Another symptom is a feeling of warmth over the affected area. Diagnosis is made only after complications develop. A unique feature of this disease is the enlargement of areas of affected bone. This is visible on an x-ray. It may also be diagnosed by the results of an Alkaline phosphatase blood test. Bone scans can also be useful in determining the extent and activity of the condition. If the bone scan suggests Paget’s disease, the affected bone(s) should be x-rayed to confirm the diagnosis. If the bones of the skull are affected, enlargement of the skull can occur and may result in a loss of hearing. If the long bones in the legs are affected, they can become bent under the body’s weight because of their weakness. Little or no injury to a bone can cause fractures in the weakened bones. Although rare, bone cancer occurs in less than one percent of patients with Paget’s disease. This is indicated with a sudden increase in the intensity of pain at the diseased site. Unfortunately this type of cancer has a poor prognosis; the average survival time from the onset of symptoms is about one to three years. Otherwise the outlook for Paget’s disease patients are generally good, particularly before major changes in the affected bones have occurred. To understand what happens in Paget’s disease, it is helpful to understand the difference between normal bone cell activity and Pagetic bone cell activity. Bone is active and living tissue that is constantly being remodeled. Normal bone cell activity is a very controlled process that is necessary for bone development and repair throughout life. Bone affected by Paget’s disease is broken down faster than usual. Thus, new bone formation increases. Because new bone formation forms so rapidly, its structures become jumbled and disorganized. Extra blood vessels appear, and the new formation becomes bulky and softer than normal bone. Because the bones are weaker than normal, they may break or fracture more easily. Treatment for Paget’s disease is most often done with drug therapy, with bone pain lessening within three weeks of starting the treatment. While non-steroidal anti-inflammatory drugs can reduce bone pain, two additional categories of drugs are used. Hormone treatment is one way to treat the disease. Calcitonin, a hormone which is made naturally by the thyroid gland, is used. This decreases the amount of bone breakdown or loss. It is usually given as daily injections for one month, followed by thre...