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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)
Long-term bisphosphonate therapy has been linked to a rare problem in which the upper thighbone cracks, but doesn't usually break completely. Bisphosphonates also may increase the risk of osteonecrosis of the jawbone — a rare condition in which a section of jawbone dies and deteriorates after a tooth extraction.
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 or nasal spray. 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.
- Paget's disease of bone. National Institutes of Health Osteoporosis and Related Bone Diseases: National Resource Center. http://www.niams.nih.gov/health_info/Pagets/default.asp. Accessed Dec. 11. 2012.
- Goldman L, et al. Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.mdconsult.com/das/book/body/191371208-2/0/1492/0.html#. Accessed Dec. 11, 2012.
- Paget's disease of bone. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00076. Accessed Dec. 11, 2012.
- Ferri FF. Ferri's Clinical Advisor 2013: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2012. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-0-323-08373-7..00002-9&isbn=978-0-323-08373-7&about=true&uniqId=343863096-23. Accessed Dec. 11, 2012.
- Seton M. Clinical manifestations and diagnosis of Paget disease of bone. http://www.uptodate.com/index. Accessed Dec. 11, 2012.
- Firestein GS, et al. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2013. http://www.mdconsult.com/das/book/body/208746819-6/0/1807/0.html. Accessed Dec. 11, 2012.
- Seton M. Treatment of Paget disease of bone. http://www.uptodate.com/index. Accessed Dec. 11, 2012.
- Nippoldt TB (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 14, 2013.
- Rosen HN. Bisphosphonates in the management of osteoporosis in postmenopausal women. http://www.uptodate.com/index. Accessed Jan. 15, 2013.
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