Paget's Disease of Bone - Treatment Overview
Many people do not need any treatment for Paget's disease. But the disease should be monitored for the rest of your life because of increased risk of complications such as inflammation of joints (arthritis), broken bones (fractures), and nerve problems. If your disease is active, you should see your doctor every 3 months. See your doctor or nurse every 6 to 12 months if Paget's disease is inactive.3
Doctors generally recommend treatment if you have symptoms or if you have no symptoms but are at risk of complications. You may be at risk if:
- Your lab tests suggest that your bone tissue is breaking down faster than normal.
- The disease is in long bones or bones that hold up the
weight of the body (such as the
thighbones
or the
spine ). You may need treatment to prevent the affected
bones from becoming brittle and breaking. - The disease affects your skull or spine. You may need treatment for nerve problems such as dizziness, hearing loss, headaches, and numbness or tingling in the body. Paget's disease in these areas may also cause deformities (such as a bowed spine) that may make walking difficult. After bowing of bones has occurred, it cannot be reversed with medicine.
- You are having bone or joint surgery. If you have Paget's disease, you need treatment with medicines to slow bone growth before surgery to reduce the risk of problems such as bleeding after surgery.
- The disease requires you to stay in bed for a long time. You may need treatment to prevent levels of calcium in the blood from getting too high.
Doctors aim treatment at slowing the breakdown of bone tissue, which may help Paget's disease to become inactive. Treatment may also reduce pain and may help prevent complications.
If you have symptoms of complications from Paget's disease, such as painful joints, you may also need treatment for these conditions.
Initial treatment
For the initial treatment of Paget's disease, doctors usually prescribe a medicine called a bisphosphonate, which reduces the breakdown of bone tissue and helps control symptoms such as bone pain. This medicine may also help prevent complications such as osteoarthritis or nervous system problems. If you cannot tolerate bisphosphonate, your doctor may prescribe another medicine, called calcitonin.
Bisphosphonates nearly always make Paget's disease inactive, sometimes for years or decades. In some people, though, Paget's disease becomes active again. So you may need to take medicine off and on for the rest of your life.
If your bone pain does not go away while you are taking medicine to slow the breakdown of bone tissue, you may need acetaminophen, or aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs).
Other treatments may include the following:
- Splints or braces to support bones and joints can help prevent weakened bones from breaking. If your doctor prescribes a splint or brace, be sure it fits properly. Splints or braces that do not fit properly can cause skin irritation.
- Canes or walkers may help you walk with less risk of falling. Ask for training in how to use these devices properly. You can also use these reminders to help you use a cane or walker safely:
- Physical therapy can help strengthen muscles, increase endurance, and improve balance.
- Home health nursing may be right for you if you are taking a medicine that must be given intravenously. Home health nurses can also help make your home safe to prevent you from falling.
- Acupuncture and relaxation techniques (such as guided imagery and biofeedback techniques) may help decrease pain in some people.
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