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Treatments and drugs
By Mayo Clinic staffIf you don't have symptoms, you may not need treatment. However, if the disease is active — indicated by an elevated alkaline phosphatase level — and is affecting high-risk sites in your body, such as your skull or spine, your doctor may recommend treatment to prevent complications, whether or not you have symptoms.
Medications
Osteoporosis drugs (bisphosphonates) are the most common treatment for Paget's disease of bone. Some bisphosphonates are given as oral medications, while others are given by injection. Oral bisphosphonates are generally well tolerated, but may irritate your gastrointestinal tract. Examples include:
- Alendronate (Fosamax)
- Ibandronate (Boniva)
- Pamidronate (Aredia)
- Risedronate (Actonel)
- Zoledronic acid (Zometa, Reclast)
If you can't tolerate bisphosphonates, your doctor may prescribe calcitonin (Miacalcin), a naturally occurring hormone involved in calcium regulation and bone metabolism. Calcitonin is a drug that you administer to yourself by injection. Side effects may include nausea, facial flushing and irritation at the injection site.
Surgery
In rare cases, you may require surgery to:
- Help fractures heal
- Replace joints damaged by severe arthritis
- Realign deformed bones
- Reduce pressure on nerves
Paget's disease often causes the body to produce an excessive number of blood vessels 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 doctor may prescribe medications to reduce the activity of the disease, a step that tends to reduce blood loss during surgery.
- Facts a new patient needs to know about Paget's disease of bone. National Institutes of Health Osteoporosis and Related Bone Diseases: National Resource Center. http://www.niams.nih.gov/health_info/bone/pagets/default.asp. Accessed May 26, 2010.
- Roodman GD. Paget's disease of bone. In: Goldman L, et al. Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/203002646-3/1004517503/1492/963.html#4-u1.0-B978-1-4160-2805-5..50273-1_12206. Accessed May 26, 2010.
- Paget's disease of bone. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00076. Accessed May 26, 2010.
- Mercier LR. Paget's disease of the bone. In: Ferri FF. Ferri's Clinical Advisor 2010. Philadelphia, Pa.: Mosby Elsevier; 2009. http://www.mdconsult.com/das/book/body/203002646-3/1004517503/2088/470.html#4-u1.0-B978-0-323-05609-0..00025-3--sc0010_9669. Accessed May 26, 2010.
- Kelepouris N. Clinical manifestations and diagnosis of Paget disease of bone. http://www.uptodate.com/home/index.html. Accessed May 27, 2010.
- Lane NE. Paget's disease of bone. In: Firestein GS, et al. Kelley's Textbook of Rheumatology. 8th ed. Philadelphia, Pa.: WB Saunders Co.; 2008. http://www.mdconsult.com/das/book/body/203002646-3/0/1807/698.html?tocnode=55733939&fromURL=698.html#4-u1.0-B978-1-4160-3285-4..10092-0--s0210_3402. Accessed May 26, 2010.
- Seton M. Treatment of Paget disease of bone. http://www.uptodate.com/home/index.html. Accessed May 27, 2010.
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