Paget’s disease (osteitis deformans) occurs with increasing frequency with each decade. It is not equally common worldwide, seeming instead to have a predilection for the populations of English-speaking countries. It is a disease of unknown cause.
Paget’s disease affects bone and may be limited to one bone or involve many. The disease process causes reabsorption of bone, a change that is visible on x-ray examination. The disease may occur without causing any symptoms, and it is common to discover the problem when the patient undergoes x-ray examination for another purpose.
When the bony changes do cause symptoms, they can include headache, changes in hearing and balance, and visible deformities of the involved bones. The enlarging bones can occasionally cause pressure on nerves, which in turn can cause pain and other neurologic symptoms. If bones in the legs become involved, bowing of these leg bones can occur. Occasionally the bones become fragile enough to cause a fracture.
The changes in the bone increase the flow of blood through the bone. Occasionally, this can be so marked that it can be felt as warmer skin overlying the affected bone. This increase in blood flow can also produce strain on the heart and in exceptional circumstances can produce heart failure.
Important Points in Treatment
Patients who have no symptoms usually do not require treatment. Treatment is with a variety of medications to slow the development of the bone changes and to reverse these changes to reduce symptoms. Patients with Paget’s disease who are asymptomatic are at little risk, although the deformities such as enlargement of the skull or bowing of the legs may be remarkably apparent. Your physician will advise you if you have bones that appear unusually susceptible to injury. Changes in the legs with bowing of the leg bones may cause some instability, and particular care should be taken to avoid falls.