Paget’s disease of bone disrupts the normal cycle of bone renewal, causing bones to become weakened and possibly deformed. Paget’s is rare in people under 40 but becomes increasingly more common with age. In the UK, it has been estimated that about 2–3 people in 100 over the age of 50 have Paget’s disease in some part of their skeleton, but it may not cause any symptoms and often goes unnoticed. Paget’s is most common in white people, although it can occur in any race.
Paget’s disease of bone can affect just one bone or several bones. Commonly affected areas include the:
- thigh bones
- shin bones
- constant, dull or aching bones
- joint pain, stiffness and swelling
- a shooting pain that travels along or across the body
- numbness and tingling
- loss of movement in part of the body
- the affected area may also feel warm
- symptoms can be worse at night
Paget’s disease of bone can also cause a range of other problems, including:
- fragile bones that are more likely to break
- deformities in affected bones, such as curved legs (bow legs) or a curved spine (scoliosis)
- hearing loss, headaches, vertigo (a spinning sensation) and tinnitus (a noise in your ears) – these may occur if the skull is affected
- too much calcium in the blood
- heart problems
Causes of Paget’s disease of bone
Bone cells regenerate in a similar way to skin – old bone is removed and replaced by new bone. This is known as bone remodelling. Two cells are responsible for this:
- osteoclasts – cells that absorb old bone
- osteoblasts – cells that make new bone
In Paget’s disease of bone, something goes wrong with the osteoclast cells and they start to absorb bone at a much faster rate than usual. The osteoblasts then try to produce new bone more quickly, but the new bone is larger and weaker than normal.
It’s not clear what triggers this, but you’re at a higher risk if you have a family history of Paget’s disease of bone. You may inherit a genetic fault that means you’re much more likely to develop the condition.
TREATMENT OF Paget’s disease of bone
There’s currently no cure for Paget’s disease of bone, but treatment can help relieve the symptoms. Paget’s disease is often treated with a group of drugs called bisphosphonates. These drugs are often used in the treatment of osteoporosis but at a different dose and for a different length of time. They work by damping down the overactive renewal and repair process, which in Paget’s disease is much faster than normal. These drugs act mainly on the osteoclasts (the cells that break down old bone) to slow down the rapid bone turnover. Drugs in this group include:
Over-the-counter painkillers such as paracetamol and ibuprofen can help relieve pain caused by Paget’s disease of bone. Make sure you read the packet or leaflet before taking painkillers, to check whether they’re suitable for you and to find out how much to take. If these do not help reduce your pain, your GP can prescribe more powerful painkillers.
Some people with Paget’s disease benefit from complementary therapies such as physiotherapy or occupational therapy. A therapy assessment, generally by a physiotherapist, can be very helpful. They can, for example, identify whether one of your legs has become shorter because your thigh and shin bones have become curved. In this case, a built-up insole in your shoes can reduce any feelings of lopsidedness.
Physiotherapists can also give you exercises that help to reduce pain, improve muscle-strength and movement, while an occupational therapist can offer you advice on walking aids and other aspects of daily living.
The physiotherapists here at the Centre are fully qualified practitioners with a wealth of experience. Read more about physiotherapy here. To book an appointment please call us on (01480) 455 221.
Devices that reduce the weight placed on the affected bones may also help, such as:
- a walking stick or frame
- orthotics – insoles made of plastic that fit inside your shoe to help support your feet
- braces that support the spine in the correct position
- Some therapists also use treatments such as transcutaneous electrical nerve stimulation (TENS) – a method of pain relief involving the use of a mild electrical current. The scientific evidence for TENS is not strong, but some people find it helpful.
Surgery is usually only needed if further problems develop, such as fractures, deformities or severe osteoarthritis.
Diet and nutrition
Calcium and vitamin D help keep your bones healthy. If you have Paget’s disease of bone, it’s important to ensure you get enough of these.
You get calcium from your diet. It’s found in foods such as:
- dairy foods – such as milk and cheese
- green leafy vegetables – such as broccoli and cabbage
- soya beans, soya drinks with added calcium and tofu
You get most of your vitamin D from sunlight, although it’s also found in some foods such as oily fish.
Sometimes your GP may suggest taking extra calcium and/or vitamin D supplements to ensure you’re getting enough.
To find out more about Paget’s Disease of Bone, visit their website.