Paget’s disease is a bone disorder.
About Paget Disease
In patients with Paget disease (Paget’s disease, Paget disease of bone), bone formation increases as a result of “excessive bone resorption”. The over activity and compensatory activity leads to woven bone, which is “a structurally disorganized mosaic of bone” that is larger, weaker, quite vascular, and more likely to fracture. This disorder was first discovered by Sir James Paget in 1877. After osteoporosis, Paget disease is the “second most common bone disorder”. While most patients don’t experience symptoms, some have bone pain, secondary osteoarthritis, excessive warmth, bone deformity (bowing), and even neurologic complications, as nerve tissues can become compressed. Any bone may be affected, and the disorder could worsen progressively, although it doesn’t spread between bones. Paget disease is thought to be brought on by environmental and genetic factors. There is “ethnic and geographic clustering”, with the disorder being mainly in Europe, Australia, New Zealand, and North America. Rarely is it found in Africa or Asia. Most people with this disorder are Caucasian. About 40% of the people with Paget disease have a family history.1 There is a possibility that the disease is brought on by “a viral infection early in life”. The most common body parts affected by this breakdown of bone followed by the formation of abnormal bones are the skull, spine, leg, arms, collarbones, and pelvis. Additional symptoms might include enlarged head, fracture, headache, reduced height, and hearing loss. Doctors can diagnose Paget disease with bone x-rays and scans and “elevated markers of bone breakdown”.2 The risks of getting this disease are higher in older people and men. Without treatment, heart failure is also a possibility.3
Paget disease does not necessarily need to be treated. Abnormal blood tests alone are not enough reason. Patients without active disease evidence or symptoms may also not require treatment. Typically, Paget disease needs intervention when weight-bearing bones are affected, if the changes in the bone are worsening rapidly, with the presence of bony deformities, when the skull is involved (hearing loss risk), and if the patient is in pain. Common drug treatments for Paget disease are bisphosphonates, to decrease remodeling of the bone, and calcitonin, a hormone that is involved with bone metabolism. For the pain, NSAIDs or acetaminophen are offered. Surgery may be necessary in some cases. Rarely, patients may develop osteosarcoma, a bone cancer, but most patients have their conditions managed by medications.4 Bisphosponates should not be used in patients with kidney disease. Calcitonin increases the risk for some cancer development. Patients should take calcium and vitamin D, avoid weight gain, engage in regular exercise, and maintain the mobility of their joints.5 Besides eating a proper diet, it is also important to prevent falls.6 Chiropractors can aid with symptomatic relief in patients with Paget disease. Because of the musculoskeletal problems that result from this disease, patients “may be aided through soft tissue therapy, therapeutic modalities, or gentle mobilization and manipulation” by a chiropractor. Patients have softened bones, and care must be taken, so it is recommended that chiropractors use “gentle non-thrust mobilization”.7