Paget’s disease of the bone, while a frequent occurrence in Western countries, is still quite uncommon in India. Read on to learn what is Paget’s disease, how it occurs, diagnosis, treatment, complications, and prevention.
What is Paget’s disease of the bone?
Paget’s disease of the bone (or osteitis deformans) is a condition where the normal process of bone remodelling is disrupted, causing bones to become weak, brittle, and spongy. It most commonly affects the tibia (shin bone), although it can also affect the spine, hips, and skull bone
What happens in Paget’s disease?
Normal bones are living tissues that undergo constant breakdown and rebuilding, a process called ‘bone remodelling’. This process is irregular in Paget’s disease, and the rate of old bone resorption and new bone formation is disproportional. While the exact cause behind this irregularity is unknown, one theory suggests that it can be due to an abnormality in osteoclasts (cells that are responsible for breaking down old bones). This causes bones to become soft in the initial stages and, later, hard and dense.
What are the symptoms of Paget’s disease?
Most commonly, people with Paget’s disease experience:
- Dull-aching pain in the affected bone
- Bowing of the legs
- Joint pain
- Headache or loss of hearing (in case the skull is affected)
- An increase in the size of your head (this can manifest as your cap or hat not fitting you anymore)
- Pain, numbness, or altered sensation in the limbs (in the case of nerve compression)
- Abdominal pain
- Constipation
- Generalised weakness and fatigue
What are the risk factors for Paget’s disease?
While the exact cause of Paget’s disease is unknown, risk factors include:
- Age: Risk increases with old age
- Gender: Men are affected more commonly than females
- Genes: A positive family history increases your risk of developing the disease
- Ethnicity: People living in Europe, the USA, and Australia are more likely to develop this condition; it is comparatively rare in Indians
How is Paget’s disease diagnosed?
Your doctor will take a detailed history of symptoms, your family history, and then examine the affected areas. In case they suspect Paget’s disease, you will be asked to undergo the following tests:
- Blood tests: These include serum calcium, serum phosphorous, parathyroid hormone, and alkaline phosphatase (ALP) levels. Usually, the latter will be raised while the other values are normal in Paget’s disease
- X-ray: An X-ray can indicate fractures, bowing of the bones, enlargement of the bones, and other deformities
- Bone scan: In this, a radioactive tracer is injected into your body through a vein. This tracer travels to various parts of the body and highlights areas with any kind of problems or abnormalities that can be seen on the scan
What’s the treatment for Paget’s disease?
Paget’s disease can be managed well with timely treatment. Most commonly, drugs called bisphosphonates are given. These are commonly employed in conditions such as osteoporosis and osteopenia. They target osteoclasts (cells that are responsible for breaking down old bones), help slow down the rate of bone breakdown, and reduce the risk of fractures and deformities.
In rare cases, surgery may be required. This is chiefly done cases of fractures, severe deformities, advanced-stage arthritis, and in cases where the disease is affecting the spine (to relieve nerve compression).
What are the complications of Paget’s disease?
Possible complications of Paget’s disease include:
- Fractures
- Osteoarthritis
- Kidney stones: This occurs due to excessive calcium in the blood, leading to calcium stones
- Heart failure: The bones in Paget’s disease are more vascular (they receive more blood supply) compared to normal bones. Thus, the heart has to work harder in order to pump blood, which can eventually lead to heart failure
- Permanent hearing loss
- Loss of vision
- Problems in the nervous system
- Rarely, it can lead to cancer
Can Paget’s disease be cured?
While Paget’s disease has no cure, timely diagnosis and treatment can help control the symptoms and prevent any complications that may occur if the condition goes untreated.
Can Paget’s disease be prevented?
Since the exact cause is unknown, Paget’s disease cannot be prevented. However, you can minimise the symptoms and complications of the disease by:
- Getting adequate vitamin D and calcium in your diet
- Reducing your risk of injuries and fractures by ensuring that your house is well-lit, wearing comfortable footwear, and installing handrails in the bathroom, toilet, and around the house
- Regularly following up with your doctor and taking your medications regularly
Is Paget’s disease related to cancer?
Paget’s disease of the bone has a small risk of cancer. Other types of Paget’s disease include:
- Paget’s disease of the nipple, which is a type of invasive breast cancer that leads to patches over the nipple and surrounding area as well as crusting, eczema-like lesions, and other skin changes
- Paget’s disease of the vulva is a type of ‘carcinoma in situ’ where the cells are abnormal and cancer-like but haven’t affected the other parts of the tissue yet. This condition is characterised by ulcer formation, redness, crusting, and a small risk of turning cancerous
- Paget’s disease of the penis and scrotum, which chiefly affects older men and is accompanied by skin changes as well
