Q: I had an X-ray to see if I had arthritis because I have pain in my joints, mostly at night, and the doctor said that I had Paget’s disease. He said that it wasn’t anything to worry about and didn’t require any treatment. What causes this?
A: Paget’s disease is found more commonly in Britain than anywhere else in the world, but it does occur in other countries. Perhaps you or your ancestors emigrated from Britain.
It is more common in people over the age of 55, gradually increasing in frequency with age and resulting in as many as 10 percent of the population having it by the age of 80.
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Many people may have it and not even know about it, since it is often symptomless and only picked up on an X-ray that may have been requested for some other reason. A blood test that measures the level of an enzyme called alkaline phosphatase can confirm the diagnosis.
Paget’s disease is caused by an abnormality in the cells that make bone, known as osteoblasts and osteoclasts.
Bone is a living tissue and is constantly being replaced, so this disease leads to increased and irregular bone formation as the affected cells go out of control. Eventually, the new bone becomes larger and weaker, with more blood vessels than normal bone. That makes those with Pagets more likely to break bones.
The disease may only involve one major bone or may be present in several bones, usually the pelvis, the femur (thigh), the tibia (leg bones) or skull.
If it is present in the weight-bearing bones, there may be pain and slowly increasing deformity or “bowing” of the leg. If it is in the skull, you may notice an increase in hat size or headaches. Sometimes pressure from increased skull enlargement can lead to deafness and dizziness.
Usually, Paget’s disease is so mild that it either goes unnoticed, or mild painkillers may be necessary. Otherwise, no treatment is required. More severe cases may require the use of drugs known as bisphosphonates. These are the same ones used to help prevent calcium loss in osteoporosis.
The most commonly prescribed medications are Fosemax and Didrical.
Clare Rowson is a medical doctor with a practice near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
