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Paget's disease of bone
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Paget's disease of bone

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From MayoClinic.com 


If you don't have symptoms, you may not need treatment. However, if the disease is active — indicated by elevated alkaline phosphatase levels — and is affecting high-risk sites in your body, your physician may recommend treatment even if you don't have symptoms because treatment may prevent complications.

Treatment for Paget's disease can help alleviate pain and may halt the damage done to your bones. In many cases, treatment can cause remission of the disease, which may be prolonged in some people.

Doctors generally recommend treatment when:

  • You experience bone pain, headaches, or neurologic symptoms related to Paget's disease.

  • You're planning to have surgery to repair damage related to Paget's disease. In this case, your physician will prescribe medications to minimize blood loss during the operation.

  • You're at risk of serious, long-term complications due to the aggressiveness of your disease and the location of your affected bones. Involvement of the backbone, skull, bones near major joints, and the long bones of the arms and legs is more likely to result in complications.

  • Your heart is overworked because of widespread Paget's disease.

If any of the above criteria applies to you, your doctor may recommend one or more of the following treatments.


Paget's disease may require treatment to reduce pain or treat the inflammation associated with arthritis. Treatment options may include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs alleviate pain and reduce the inflammation that's often the source of pain in arthritis related to Paget's disease. They work by inhibiting your body's production of two forms — COX-1 and COX-2 — of the enzyme cyclooxygenase, which is responsible for the production of hormone-like substances involved in pain and inflammation. Nonprescription NSAIDs used to relieve pain associated with Paget's disease include aspirin and ibuprofen (Advil, Motrin, others). NSAIDs available by prescription include diclofenac sodium (Voltaren), indomethacin (Indocin), nabumetone (Relafen), piroxicam (Feldene) and sulindac (Clinoril).

  • You may need to try more than one NSAID before finding the one that's most effective for you. Long-term use of NSAIDs or use of more than one NSAID can cause side effects such as ulcers, heartburn, nausea and stomach bleeding. Large doses of NSAIDs can lead to kidney problems.

  • Acetaminophen (Tylenol, others). Acetaminophen may provide some relief of your pain, but it doesn't improve inflammation. It's generally safe if you take it for a short period of time and adhere to the daily dosage guidelines. If taken at the maximum dose for extended periods of time — especially when combined with regular alcohol intake — acetaminophen may cause liver damage.

Your physician may recommend bone-regulating medications if you have Paget's-related pain or if you're at risk of serious complications. Two kinds of medications are used to treat Paget's disease of bone:

  • Biphosphonates. Doctors commonly use these medications to treat osteoporosis, increase bone density and reduce the activity of Paget's disease. They're currently the treatment of choice for Paget's disease.

  • Treatment with these agents helps restore more normal-appearing bone and may produce long-term remission of Paget's disease. Your doctor may prescribe one of four biphosphonate drugs: pamidronate (Aredia), alendronate (Fosamax), risedronate (Actonel) or etidronate (Didronel).

  • Oral biphosphonates are generally well tolerated but may cause irritation of the esophagus, diarrhea and nausea. Pamidronate isn't available as an oral medication, and you must receive it through a vein (intravenous infusion). Intravenous administration offers a more rapid response than oral medications and provides an option when you can't tolerate or are not a candidate for oral bisphosphonates.

  • Doctors usually prescribe biphosphonates for 2 to 6 months, depending on the drug used. You may need to switch to another brand if you take these medications long-term because resistance to one biphosphonate may build over time. You should not take etidronate — the least effective of the bisphosphonates — for longer than 6 months at a time.

  • Calcitonin. If you can't tolerate biphosphonates, your physician may prescribe calcitonin (Miacalcin), a naturally occurring hormone involved in calcium regulation and bone metabolism. Calcitonin is given by self-administered injection.

  • Side effects may include loss of appetite, nausea, facial flushing, frequent urination and irritation at the injection site. Stopping treatment with calcitonin usually results in a rapid reactivation of the disease and recurrence of symptoms.

Your physician may use blood tests measuring your alkaline phosphatase level to monitor your response to these medications. If therapy is effective, your alkaline phosphatase level will decrease and may return to normal.


In rare cases, you may require surgery to help fractures heal, to replace joints damaged by severe arthritis or to realign deformed bones. If Paget's disease affects your spine or your skull, you may need surgery to reduce pressure on nerves and prevent serious complications.

Paget's disease often causes the body to produce an excessive number of blood vessels (hypervascularity) in the affected bones. This change increases the risk of serious blood loss during an operation. If you're scheduled for surgery that involves bones affected by Paget's disease, your physician may prescribe medications to reduce the activity of the disease, a step that tends to reduce blood loss during surgery.


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