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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.
Treatment for Paget's disease can help alleviate pain and may halt the damage done to your bones. In many cases, treatment can cause remission of the disease, which may be prolonged in some people.
Doctors generally recommend treatment when:
- You experience bone pain or neurological signs or symptoms related to Paget's disease.
- You're planning to have surgery to repair damage related to Paget's disease. In this case, your doctor will prescribe medications to minimize blood loss during the operation.
- You're at risk of serious, long-term complications due to the aggressiveness of your disease and the location of your affected bones. Involvement of the spine, skull, bones near major joints, and the long bones of the arms and legs is more likely to result in complications.
- Your heart is overworked because of widespread Paget's disease.
If any of the above criteria apply to you, your doctor may recommend treatment.
Medications
Your doctor may recommend bone-regulating medications if you have Paget's-related pain or if you're at risk of serious complications. Doctors use two kinds of medications to treat Paget's disease of bone:
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Bisphosphonates. Doctors commonly use these medications to treat osteoporosis and increase bone density, but they may also use them to reduce the activity of Paget's disease. Treatment with these agents helps restore more-normal-appearing bone and may produce long-term remission of Paget's disease. Bisphosphonates are currently the treatment of choice for Paget's disease, but you can't take them if you have serious kidney disease.
Some bisphosphonates are given as oral medications, while others are given through a vein (intravenously). Oral bisphosphonates are generally well tolerated, but may irritate your gastrointestinal tract. Intravenous administration offers a more rapid response than oral medications do and also provides an option when you can't tolerate oral bisphosphonates.
Doctors usually prescribe bisphosphonates for two to six months, depending on the drug used. You may need to switch to another brand if you take these medications long term because resistance to one bisphosphonate may build over time.
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Calcitonin. 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. Stopping treatment with calcitonin usually results in a rapid reactivation of the disease and recurrence of symptoms.
Your doctor may use blood tests measuring your alkaline phosphatase level to monitor your response to these medications. If therapy is effective, your alkaline phosphatase level will decrease and may return to normal.
Dealing with arthritis
Paget's disease may also require treatment to reduce pain or treat the inflammation associated with arthritis. Treatment options include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs alleviate pain and reduce the inflammation that's often the source of pain in arthritis related to Paget's disease. NSAIDs come in prescription and nonprescription forms. You may need to try more than one NSAID before finding the one that's most effective for you. Long-term use of NSAIDs or use of more than one NSAID can cause side effects, such as ulcers, heartburn, nausea and stomach bleeding. Large doses of NSAIDs can lead to kidney problems.
- Acetaminophen. Acetaminophen (Tylenol, others) may provide some relief of your pain, but it doesn't improve inflammation. It's generally safe if you take it for a short period of time and adhere to the daily dosage guidelines. If taken at the maximum dose for extended periods — especially when combined with regular alcohol intake — acetaminophen may damage your liver.
Surgery
In rare cases, you may require surgery to help fractures heal, to replace joints damaged by severe arthritis or to realign deformed bones. If Paget's disease affects your spine or your skull, you may need surgery to reduce pressure on nerves and prevent serious complications.
Paget's disease often causes the body to produce an excessive number of blood vessels (hypervascularity) to 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.
