Paget Disease of Bone
A disorder of bone renewal that weakens and enlarges bone
Quick Facts
- Type: Chronic bone (metabolic) disorder
- Commonly affected: Pelvis, spine, skull, legs
- Main symptoms: Bone pain, deformity, fractures (often none early)
- Typical age: More common after age 50
Overview
Bone is living tissue that is constantly being broken down and rebuilt in a balanced cycle. In Paget disease of bone, this cycle becomes overactive and disorganized in one or more areas of the skeleton. The body breaks down bone too quickly and then rebuilds it too fast, producing bone that is larger but structurally weaker, softer, and more prone to deformity and fracture.
Paget disease most often affects the pelvis, spine, skull, and long bones of the legs. It tends to appear later in life and may affect a single bone or several. Many people have no symptoms and are diagnosed by chance, while others develop bone pain, deformity, or complications. With modern treatment, the overactive bone turnover can usually be controlled, and many people do well.
Symptoms
Many people with Paget disease have no symptoms, and it is found incidentally on X-rays or blood tests. When symptoms occur, they depend on which bones are involved.
- Bone pain, which may be deep, aching, and constant
- Enlarged or misshapen bones, such as a bowed leg or increased skull size
- Joint pain or arthritis in joints near affected bones
- Fractures, sometimes after minor injury, because the bone is weaker
- Headaches or hearing loss if the skull is involved
- Numbness, tingling, or weakness if enlarged bone presses on nerves, especially in the spine
Symptoms usually develop slowly over time. Sudden, severe pain in an affected bone should be checked, as it may indicate a fracture or, rarely, another problem.
Causes
The exact cause of Paget disease is not fully understood, but several factors appear to play a role:
- Genetic factors: The disease can run in families, and certain inherited gene changes increase the risk.
- Possible environmental triggers: Some researchers have suggested viral or other environmental influences, though this is not proven.
The disease is not caused by diet or lifestyle, and it is not contagious. It involves an abnormality in the bone cells that break down and rebuild bone, leading to the overactive, disorganized turnover that defines the condition.
Risk Factors
- Older age, with the condition becoming more common after about age 50
- A family history of Paget disease of bone
- Ancestry from certain regions where the disease is more common
- Being male, as it is somewhat more frequent in men
Diagnosis
Paget disease is often suspected from an X-ray or a blood test done for another reason, then confirmed with further tests.
- X-rays: Show the characteristic enlarged, thickened, or misshapen bone.
- Blood tests: A raised level of alkaline phosphatase, a marker of bone activity, suggests increased bone turnover.
- Bone scan: A whole-body scan that highlights all the bones affected.
- Additional imaging: CT or MRI may be used to assess complications or nerve compression.
These tests confirm the diagnosis, show how much of the skeleton is involved, and help monitor the response to treatment.
Treatment
Treatment aims to control the overactive bone turnover, relieve pain, and prevent complications. Not everyone needs treatment, but it is often recommended when there are symptoms or when important bones are affected.
- Bisphosphonate medicines: The main treatment, these drugs slow down the excessive bone breakdown and rebuilding and can relieve pain.
- Pain relief: Simple painkillers or anti-inflammatory medicines to manage bone and joint pain.
- Supportive measures: Adequate calcium and vitamin D, physical therapy, and aids such as canes or braces.
- Surgery: Occasionally needed to repair fractures, replace severely damaged joints, realign deformed bones, or relieve nerve compression.
With treatment, bone activity often returns toward normal, symptoms improve, and the risk of complications is reduced. Regular follow-up and monitoring help keep the disease controlled.
Prevention
- There is no known way to prevent Paget disease, but complications can be reduced
- Maintain adequate calcium and vitamin D intake to support bone health
- Stay active to keep bones and joints strong, following advice on safe exercise
- Take precautions to prevent falls, since affected bones are more fragile
- Attend regular check-ups so the disease can be monitored and treated
When to See a Doctor
See a doctor if you have persistent bone or joint pain, notice a change in the shape of a bone, or develop new hearing problems or headaches. Seek prompt medical attention if you have:
- Sudden, severe pain in an affected bone, which may signal a fracture
- New numbness, tingling, weakness, or loss of bladder or bowel control, which can indicate nerve compression
- A rapid increase in pain or swelling over an affected bone
Frequently Asked Questions
Is Paget disease of bone cancer?
No. Paget disease is a noncancerous disorder of bone renewal, not a cancer. Very rarely, a cancer of bone can develop in an area affected by long-standing Paget disease, which is why new severe pain or swelling in an affected bone should be checked, but this complication is uncommon.
Does Paget disease always cause symptoms?
No. Many people have no symptoms and are diagnosed by chance on an X-ray or blood test done for another reason. When symptoms do occur, they may include bone pain, deformity, fractures, or, if the skull or spine is involved, hearing loss or nerve problems.
How is Paget disease treated?
The main treatment is bisphosphonate medicines, which slow the overactive breakdown and rebuilding of bone and can relieve pain. Treatment also includes pain relief, adequate calcium and vitamin D, and sometimes surgery for fractures, deformities, or severely damaged joints.
Can Paget disease be cured?
There is no cure, but treatment is usually very effective at controlling the disease. Bisphosphonate medicines can return bone turnover toward normal, relieve symptoms, and reduce the risk of complications. Regular follow-up helps keep the condition well managed.
What bones does Paget disease usually affect?
It most often affects the pelvis, spine, skull, and the long bones of the legs. It may involve a single bone or several. The location of the affected bones determines which symptoms, such as pain, deformity, or hearing loss, a person may experience.
References
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Paget's Disease of Bone.
- Mayo Clinic. Paget's disease of bone — Symptoms and causes.
- MedlinePlus, U.S. National Library of Medicine. Paget disease of bone.
- National Institutes of Health (NIH), Bone health resources.