An Overview of Paget's Disease of Bone

Symptoms, Causes, Diagnosis, and Treatment

In This Article
Table of Contents

Paget's disease of bone is the second most common metabolic bone condition behind osteoporosis, causing accelerated bone growth leading to tumors and increased bleeding from fractures. Paget's disease of bone affects one or more bones in the body.

The body is supposed to break down old bone and replenish it over time. Paget's disease of bone accelerates that process which includes the regrowth of new bone. The resulting accelerated bone growth leads to abnormal growth, including deformities and bones that are prone to fractures. Paget's disease can often go completely without symptoms and inadvertently might be detected only through an X-ray or a surgery performed for a different reason.

Paget's disease diagnosis
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Symptoms

Paget's disease of bone might not have any symptoms at all. Most patients never know they have it and only through diagnostic tests that are looking for other medical conditions do doctors discover the disease.

However, there are patients who have complaints from Paget's disease. These include:

  • Pain in the hips, legs, or arms 
  • Headaches, hearing loss, or visual changes when it affects the bones of the skull
  • Numbness, tingling, or weakness in the arms and legs from bone growth compressing nerves
  • Osteoarthritis
  • Bowing or deformity of the legs or arms
  • Growths or deformity of the skull

If you experience a new onset of pain or weakness in an arm or leg, you should make an appointment with a doctor or healthcare professional for an evaluation to determine the cause and appropriate treatment.

Causes

Medical experts don't really know how Paget's disease is acquired or what causes it to develop. Scientists suggest that the causes are a combination of both genetic and environmental factors, with some theories reporting a possible association with exposure to a virus.

The genetic component is thought to make the patient vulnerable to the disease while the environmental trigger causes the disease to affect the patient. Another theory is that the disease is caused entirely by a virus, although that is a less popular opinion.

Paget's disease of bone is the second most common metabolic bone condition, possibly affecting about two percent of people aged at least 55 years living in areas where it is found. Only osteoporosis is more prevalent.

There is a hereditary component and Paget's disease of bone is more common for people of northern European descent. It is a bit more common in men than women and unusual in people before reaching the age of 40.

The prevalence of Paget's disease of bone has been decreasing in recent years. Some scientists have associated this with the development of vaccines for certain types of viruses, including measles. However, this has not been definitively proven.

Diagnosis

Some patients are diagnosed incidentally, when getting a diagnostic test for another reason. If you are having symptoms, your doctor will most likely order X-rays and possibly a bone scan, also known as bone scintigraphy, to look for growths and tumors caused by the disease.

Your doctor may order a lab test to determine the levels of alkaline phosphatase in your blood. Elevated levels indicate the active presence of metabolic diseases such as Paget's disease of bone.

Treatment

Depending on symptoms, treatment ranges from monitoring to the use of bisphosphonates, the same class of medications used for the treatment of osteoporosis. Your doctor will likely order treatment if you are experiencing pain or discomfort.

If symptoms are severe enough, surgery might be indicated to correct areas where bone growth is encroaching on other functions.

Coping

There is no cure for Paget's disease of bone. Your doctor may prescribe treatment to manage the condition or you might be able to continue without changes. Many patients with Paget's disease of bone live their entire lives without knowing they have the condition. If you have Paget'sdisease, even without symptoms, you may be more susceptible to fractures and have an increased risk of bleeding if a bone is broken.

It is important to reduce chances for falling by modifying the home environment to reduce risk, and by getting plenty of exercise focusing on strength, balance, and mobility. You can optimize bone health by eating a proper diet including plenty of calcium and vitamin D, but check with your physician before taking supplements if you have a history of kidney stones.

Less than 1% of patients with this condition develop bone cancer, but it is important to maintain surveillance with your doctor after a diagnosis of Paget's disease of bone.

A Word From Verywell

Paget's disease of bone is one of the more common metabolic bone conditions that people can have for years and not realize it. You may have been given a diagnosis of Paget's disease of bone and haven't had any symptoms. If your doctor discovered the disease through a blood test or X-ray and feels that treatment is necessary, make sure you understand why. Your doctor may be concerned about bone growth affecting other areas and just wants to assure that you remain symptom-free.

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Article Sources
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  1. Paget’s Disease of Bone. American Academy of Orthopaedic Surgeons. 

  2. Paget’s Disease of Bone. American College of Rheumatology. 2019.

  3. Information for People Newly Diagnosed With Paget’s Disease of Bone. National Institutes of Health. 2018.

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  7. Tuck SP, Layfield R, Walker J, Mekkayil B, Francis R. Adult Paget's disease of bone: a review. Rheumatology (Oxford). 2017;56(12):2050-2059. doi:10.1093/rheumatology/kew430

  8. How Is Paget’s Disease of Bone Diagnosed?. National Institutes of Health. 2018.

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Additional Reading
  • Alonso N, Calero-Paniagua I, Del Pino-Montes J. Clinical and Genetic Advances in Paget's Disease of Bone: a Review. Clin Rev Bone Miner Metab. 2016;15(1):37-48. DOI: 10.1007/s12018-016-9226-0

  • Galson DL, Roodman GD. Pathobiology of Paget's Disease of Bone. J Bone Metab. 2014;21(2):85-98. DOI: 10.11005/jbm.2014.21.2.85

  • Kang H, Park YC, Yang KH. Paget's Disease: Skeletal Manifestations and Effect of Bisphosphonates. J Bone Metab. 2017;24(2):97-103. DOI: 10.11005/jbm.2017.24.2.97

  • Merashli M, Jawad A. Paget's Disease of Bone among Various Ethnic GroupsSultan Qaboos Univ Med J. 2015;15(1):e22-6.

  • Nebot Valenzuela E, Pietschmann P. Epidemiology and pathology of Paget's disease of bone - a review. Wien Med Wochenschr. 2016;167(1-2):2-8. DOI: 10.1007/s10354-016-0496-4