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Paget's disease is an illness of the bones, usually causing them to become enlarged and deformed. Worldwide, it is the second most common bone disease, after osteoporosis. It is named after Sir James Paget, who first diagnosed the disease in 1877. Learn more about Paget's disease by taking this quiz, based on information from the National Institutes of Health.
1. The hallmark of Paget's disease is that the body's normal process of reabsorbing bone is:
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Throughout your life, your body is continually absorbing (breaking down) bone and building new bone. In a person with Paget's disease, the absorption process is greatly speeded up. The acceleration is caused by a dramatic increase in the size of special cells called osteoclasts, which break down bone material. In a person with Paget's disease, the osteoclasts are five times larger than normal. The rapid absorption of bone triggers new bone formation, often more than was there originally. But the newly formed bone is of poor quality, with less strength and durability than normal bone.
2. Researchers believe that Paget's disease may be caused by:
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Researchers say a "slow virus" infection—one that works on the body for many years—may be the main cause of the illness. A gene may also play a role in the development of the disease because Paget's tends to run in families.
3. Paget's disease most often strikes which age group?
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It is rare in people younger than 40. Both men and women can develop Paget's disease.
4. The symptoms of Paget's disease are often confused with:
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Although it is not arthritis, Paget's disease can lead to arthritis, as damaged bones put pressure on nearby joints or cause excessive wear and tear on joint surfaces. In many cases, however, people are not aware that they have Paget's disease because they have no symptoms. Symptoms, when they do appear, include bone pain, fractures, headache (if bones in the skull or spine are affected), hearing loss (because of damage to the small bones in the ear), curvature of the spine, pressure on nerves, and hip pain. Symptoms progress slowly.
5. Which bones are most commonly affected by Paget's disease?
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Any bone in the body can be affected by Paget's disease, but those most commonly affected are those in the spine, skull, pelvis, thighs, and lower legs. Usually, Paget's affects only one or two bones, and sometimes only part of a bone.
6. A doctor can best diagnose Paget's disease with which test?
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A bone scan can tell the doctor how much bone is affected by the disease. An X-ray can confirm a diagnosis of the disease, because affected bones have a particular look on an X-ray. An elevated level of alkaline phosphatase can indicate Paget's disease. People with a family history of the disease can have their alkaline phosphatase level checked every two to three years, so that treatment can begin promptly if the test is positive.
7. In addition to osteoarthritis, Paget's disease may lead to what other disorders?
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When Paget's disease affects the bones of the inner ear, hearing loss may occur in one or both ears. In people with severe Paget's disease, the heart must work harder to pump blood to the bones that are affected by the disease. This can cause problems if the person also has hardening of the arteries. A person with Paget's is more likely to develop kidney stones. Other disorders associated with Paget's disease include nervous system problems, when an affected bone puts pressure on the brain, spinal cord, or nerves; loose teeth or chewing problems, when the affected bones are in the face; and, rarely, vision loss, when the optic nerve is affected. Paget's disease is not associated with osteoporosis; they are completely different disorders.
8. Treatment of Paget's disease may involve which of these?
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For many cases of Paget's disease, no treatment is needed. When pain is present, a nonsteroidal anti-inflammatory drug can offer relief. Steroids also may be prescribed. More severe cases can be treated with biphosphonates, which reduce bone absorption, or with calcitonin. In addition, a person with Paget's should take 1,200 mg of calcium and 400 units of vitamin D each day. A person with a history of kidney stones, however, should discuss these supplements with his or her health care provider before taking them. Exercise also is important for a person with this disease, but the type of exercise should be discussed with the person's health care provider. Surgery may be necessary to help realign bones or to replace damaged joints.
