bone, joint, and muscle disorders
Paget Disease of Bone
Treatment of Paget Disease of Bone
Treatment of pain and complications Bisphosphonates A person who has Paget disease needs treatment if the symptoms cause discomfort or if there is a significant risk or suggestion of complications, such as hearing loss, osteoarthritis, and deformity. People who do not have symptoms may not need any treatment. Commonly used pain relievers (analgesics) such asacetaminophenand nonsteroidal anti-inflammatory drugs (NSAIDs) help reduce bone pain. If one leg becomes bowed and shortened, heel lifts can help make walking easier. Sometimes surgery is needed to relieve pinched nerves or to replace a joint that has become arthritic from Paget disease. Bisphosphonates are medications that inhibit bone turnover and can be used to slow the progression of Paget disease.Zoledronic acidis the bisphosphonate of choice. Other bisphosphonates such asalendronate,risedronate,pamidronate, tiludronate, and etidronate are sometimes used as an alternative. Except forpamidronateandzoledronic acid, which are usually given by vein (intravenously), these medications are given by mouth. These medications are given to treat pain caused by Paget disease and not by another source, such as osteoarthritis. Bisphosphonates are also sometimes indicated for the following clinical scenarios: Before orthopedic surgery to prevent or reduce bleeding during surgery To prevent or slow the progression of complications (such as hearing loss, bone deformity, arthritis, weakness, or paralysis), especially in people who cannot have surgery For people with a blood level of alkaline phosphatase twice the normal level or higher Calcitoninis occasionally used as an alternative to bisphosphonates in people who cannot take bisphosphonates or do not tolerate them.Calcitoninis injected under the skin or into muscle. Doctors encourage weight bearing (such as standing and walking) and discourage excessive bed rest (except for sleeping at night). Because bone is being remodeled rapidly, people should consume adequate amounts of calcium andvitamin Din their diet.Vitamin Dhelps the body absorb calcium and add it to bone (a process called bone mineralization).Vitamin Dand calcium supplements are often needed. Otherwise, poor bone mineralization and bone weakening (osteomalacia) may occur. 