Paget's disease

Treating Paget's disease

If a blood test reveals that you have Paget’s disease but you are not experiencing any symptoms, a policy of "watchful waiting" is likely to be recommended. This means that you will not receive treatment immediately, but your progress will be carefully monitored using regular blood tests.

Treatment is usually recommended if you have symptoms that are associated with Paget’s disease, such as bone pain or neurological symptoms (those that affect the nerves, causing symptoms such as pain, numbness and tingling).

The short-term aim of treatment for Paget’s disease is to relieve symptoms. The long-term aim is to prevent the condition from getting worse and to reduce the risk of complications developing.

Treatment options for Paget’s disease include:

  • medication to help regulate bone remodelling
  • medication to relieve pain
  • surgery

Regulating bone remodelling

There are a number of different medications that can be used to help regulate bone growth in cases of Paget’s disease. These are outlined below.

Bisphosphonates

Bisphosphonates are the first choice medications that are used to regulate bone growth. These medicines work by suppressing (controlling) the actions of the osteoclasts cells, which means that the bone remodelling process should return to normal.

A type of bisphosphonate called risedronate is usually recommended because it has proved to be effective in treating Paget’s disease. Risedronate is available in tablet form and most people are advised to take one tablet a day over the course of a two-month period.

It is usually recommended that risedronate is taken first thing in the morning, 30 minutes before eating or drinking anything (other than plain water).

Take your risedronate tablet while you are standing or sitting up and avoid lying down for at least 30 minutes after taking it. This will help prevent heartburn (burning chest pain and discomfort).

Side effects of risedronate include:

If you are unable to take risedronate because you are unable to stay upright for 30 minutes, there are alternative bisphosphonates, such as pamidronate, that can be used. Pamidronate is given by injection, usually once a week over the course of six weeks.

The most common side effects of pamidronate include:

  • mild, flu-like symptoms, such as high temperature
  • joint pain
  • headaches
  • chills

However, these side effects usually pass within 48 hours of receiving an injection.

Zoledronic acid

Zoledronic acid is a new type of bisphosphonate that is increasingly being used as an alternative to risedronate or pamidronate.

Zoledronic acid is a long-acting medication so you will only need to be given one injection a year.

Flu-like symptoms, such as chills, fever and joint pain are common after receiving your first injection, although these side effects should pass within three to four days.

Calcitonin

If you have low levels of calcium in your blood (hypocalcemia), you will probably be unable to use bisphosphonates safely. This is because bisphosphonates can lower your calcium levels further which could be potentially dangerous.

In such circumstances, an alternative medication called calcitonin may be recommended. Calcitonin is a synthetic (man-made) version of a hormone that is known to prevent bone loss. It is given by injection once a day. The recommended course will depend on how well you respond to treatment.

If you require a relatively long course of treatment, training can be given so that you can administer the injections yourself.

Common side effects of calcitonin include:

  • headaches
  • changes in how things taste
  • nausea
  • abdominal pain
  • vomiting
  • diarrhoea
  • fatigue
  • dizziness

If you experience feelings of dizziness when taking calcitonin, avoid driving or operating machinery.

Painkillers

In most cases, painkillers that are available over the counter, such as paracetamol or ibuprofen, should be effective in relieving the symptoms of bone pain. If your symptoms continue, your GP can prescribe more powerful painkillers.

Physiotherapy

Some people with Paget’s disease find that they benefit from having physiotherapy, particularly those who have had fractures or other types of damage in the bones of their legs or spine.

A physiotherapist will be able to advise you about the use of equipment that is designed to reduce the weight placed on affected bones. This should help to reduce pain and make everyday physical activities easier. Examples include:

  • walking devices – such as a cane or walking frame
  • orthoses – insoles that are made out of plastic and fit inside your shoe to hep support your feet
  • spine braces – designed to support the spine in the correct position

Some physiotherapists also provide energy-based therapy which uses different types of energy, such as electric currents or impulses to stimulate the nervous system. The electric impulses are thought to be effective in easing pain and promoting healing in some people.

The physiotherapist will also be able to teach you a number of exercises that can:

  • improve your muscle strength
  • maintain the range of movement and flexibility in your joints
  • increase your physical stamina

See the Health A-Z topic about physiotherapy for more information and advice.

Surgery

If you develop a fracture in a bone, surgery may be required to realign the bones so that the affected bone is able to heal properly. See the Health A-Z page about treating broken bones for more information.

If you experience severe osteoarthritis (joint inflammation and damage), surgery may be required to repair or replace a damaged joint. Surgical options for osteoarthritis include:

  • an arthroplasty – where the damaged joint is removed and replaced with an artificial joint; the most commonly performed arthoplasties are hip replacements and knee replacements
  • arthrodesis – where the joint is fused into a in a permanent position

Dietary supplements

If you have Paget’s disease, your GP may recommend that you take regular vitamin D and calcium supplements. Both of these help to strengthen your bones.

Some bisphosphonates (see right) can also reduce the levels of calcium in your body, so you may need to "top up" your levels by taking supplements.

Glossary

Anti-inflammatory
Anti-inflammatory medicines reduce swelling and inflammation.
Deformity
Deformity is used to describe a part of the body that is not the usual shape. This could develop during pregnancy or as a result of a condition or injury.
Joint
Joints are the connection point between two bones that allow movement.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Painkillers
Analgesics are medicines that relieve pain. For example paracetamol, aspirin and ibuprofen.
Last updated: 28 December 2012

Continue to next section: Complications of Paget's disease