Paget’s disease of bone is a chronic (long-lasting) disorder that causes bones to grow larger and become weaker than normal. The disease usually affects just one or a few bones. The bones most commonly affected by Paget’s disease include:

• Pelvis.
• Skull.
• Spine.
• Femur and tibia (leg bones).

Many people with Paget’s disease do not experience symptoms specific to the disease. However, the bone changes can cause:

• Bone pain.
• Misshapen bones.
• Broken bones (fractures).
• Inflammation and arthritis in the joints close to the affected bones.

With treatment, many people can manage their symptoms, improve pain, and control the effects of the disease.

What Happens in Paget’s Disease?

Throughout your lifetime, the body constantly removes old bone and adds new bone to the skeleton. As we age, it is normal for this process to happen at a slower pace. As the disease starts, the body loses much more bone than it makes. As Paget’s disease progresses, new bone forms at a faster rate than the rate at which old bone is removed. However, the new bone does not form correctly, leading to larger bones that are misshapen, weaker, and softer than normal bone.

Paget disease of bone is a disorder that causes bones to grow larger and weaker than normal. Affected bones may be misshapen and easily broken (fractured).

The classic form of Paget disease of bone typically appears in middle age or later. It usually occurs in one or a few bones and does not spread from one bone to another. Any bones can be affected, although the disease most commonly affects bones in the spine, pelvis, skull, or legs.

Many people with classic Paget disease of bone do not experience any symptoms associated with their bone abnormalities. The disease is often diagnosed unexpectedly by x-rays or laboratory tests done for other reasons. People who develop symptoms are most likely to experience pain. The affected bones may themselves be painful, or pain may be caused by arthritis in nearby joints. Arthritis results when the distortion of bones, particularly weight-bearing bones in the legs, causes extra wear and tear on the joints. Arthritis most frequently affects the knees and hips in people with this disease.

Other complications of Paget disease of bone depend on which bones are affected. If the disease occurs in bones of the skull, it can cause an enlarged head, hearing loss, headaches, and dizziness. If the disease affects bones in the spine, it can lead to numbness and tingling (due to pinched nerves) and abnormal spinal curvature. In the leg bones, the disease can cause bowed legs and difficulty walking.

A rare type of bone cancer called osteosarcoma has been associated with Paget disease of bone. This type of cancer probably occurs in less than 1 in 1,000 people with this disease.

Early-onset Paget disease of bone is a less common form of the disease that appears in a person's teens or twenties. Its features are similar to those of the classic form of the disease, although it is more likely to affect the skull, spine, and ribs (the axial skeleton) and the small bones of the hands. The early-onset form of the disorder is also associated with hearing loss early in life.

Classic Paget disease of bone occurs in approximately 1 percent of people older than 40 in the United States. Scientists estimate that about 1 million people in this country have the disease. It is most common in people of western European heritage.

Early-onset Paget disease of bone is much rarer. This form of the disorder has been reported in only a few families.

Paget’s disease and osteoarthritis are different disorders that share some of the same symptoms; namely, joint and bone pain. This fact sheet describes the differences between Paget’s disease of bone and osteoarthritis, the similarities in their symptoms, how Paget’s disease can cause osteoarthritis, and issues related to diagnosis and treatment.

What is Paget’s disease?

Paget’s disease is a chronic disorder that can result in enlarged and misshapen bones. The excessive breakdown and formation of bone tissue causes affected bone to weaken, resulting in pain, misshapen bones, fractures, and other bone and joint problems, including osteoarthritis. Paget’s disease typically is localized, affecting just one or a few bones, as opposed to osteoporosis, for example, which affects all the bones in the body. Scientists do not know for sure what causes Paget’s disease.

What is osteoarthritis?

Osteoarthritis is a condition that causes changes in cartilage, the elastic tissue that cushions the joints. Healthy cartilage allows bones to glide over one another, while absorbing energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together, causing pain, swelling, and loss of motion of the joint.

Distinguishing between Paget’s disease and osteoarthritis

Not everyone with Paget’s disease will develop osteoarthritis. Among those who have both, some may have osteoarthritis caused by the Paget’s disease while others will simply have two unrelated conditions.

Both Paget’s disease and osteoarthritis can cause joint and bone pain. In people with both conditions, joint and bone pain can occur in the same areas of the body. This can sometimes make it difficult for doctors to tell which condition is causing the pain.

No single test can diagnose osteoarthritis. The diagnosis of osteoarthritis in a person with Paget’s disease may involve blood tests, x-ray images, or the examination of fluid drawn from the joint. Blood and urine tests may also be used to help find out if something other than Paget’s disease is causing the arthritis.

The bone changes revealed by x-ray images help doctors diagnose both osteoarthritis and Paget’s disease. However, in people who have both conditions in the same area of the body, it is often difficult to distinguish between the two. For this reason, the judgment of the patient’s doctor is critically important for accurate diagnosis and effective treatment.

How does Paget’s disease cause osteoarthritis?

Although they are different conditions, there is a link between Paget’s disease and osteoarthritis. The changes that occur in bones affected by Paget’s disease can also affect the function of nearby joints. As a result, people with Paget’s disease frequently have osteoarthritis. Paget’s disease can cause osteoarthritis when it:

• Changes the shape of bones under the cartilage of the joint.
• Causes long bones (such as the thigh or leg) to bow and bend, placing excess stress on the joints.
• Causes changes in the normal curvature of the spine.
• Softens the pelvis, affecting the hip joint.

What are the available treatments?

The treatment strategies for Paget’s disease and osteoarthritis are quite different, so it is important to distinguish between the two when making therapy-related decisions. For example, people with both disorders who get good results from their Paget’s disease treatment may continue to experience osteoarthritis-related pain. Correctly identifying osteoarthritis as the source of pain is critical to the selection of effective treatments.

The goal of osteoarthritis therapy is to improve joint function and control pain and swelling. Treatment approaches include exercise, weight control, rest, joint care, prescription and over-the-counter medicines, pain relief techniques, and complementary therapies such as tai chi and nutritional supplements. In certain cases, surgery on the affected joint may be needed.

The goal of Paget’s disease therapy is to relieve pain and control the progress of the disorder. Treatment strategies include the use of prescription medications approved for Paget’s disease, over-the-counter pain medications, appropriate forms of exercise, and, in some cases, surgery on the affected bone or joint.

Because effective therapies are available for both Paget’s disease and osteoarthritis, the results of the combination of the two disorders need not be severe. This is particularly true when treatment for Paget’s disease begins before major complications have developed.

What is Paget’s disease of bone?

Paget’s disease of bone causes bones to grow larger and weaker than normal. The disease may affect one or more bones, but does not spread from affected bones to other bones in the body. Paget’s disease can affect any bone in your body, but most people have it in their pelvis, skull, spine, or leg bones. These bones may become misshapen and, because they are weaker than normal bones, can break more easily. Some people with Paget’s disease feel pain in these bones, too.

I’ve never heard of Paget’s disease before. How common is it?

Uncommon in people under age 40, Paget’s disease grows more common with age. The condition is more common in people of Anglo-Saxon descent in certain geographical areas, including England, the United States, Australia, New Zealand, and Western Europe. It is not common in Scandinavia, China, Japan, or India.

Is Paget’s disease a form of arthritis?

People with Paget’s disease often have arthritis at the same time, but they are different diseases. Sometimes Paget’s disease is confused with arthritis because the pain from Paget’s disease may be located on the part of the bone closest to a joint. So, it may feel a lot like the joint pain of arthritis. Paget’s disease can cause arthritis over time when enlarged and misshapen bones put extra stress on nearby joints. Your doctor may use several tests find out if you have Paget’s disease.

How did I get Paget’s disease?

Doctors are not sure what causes the disease. Some people have hereditary Paget’s disease, which means it runs in their family and was passed down by their parents. But most people do not have any relatives with Paget’s disease. Doctors think a virus may cause Paget’s disease in some cases. They are studying different kinds of viruses to try to find ones that may cause the disease.

Will my Paget’s disease get worse? What should I expect?

Paget’s disease does not affect everyone in the same way. Some people have a very mild case with few or no symptoms. Others have symptoms and complications. Pain is the most common symptom. Depending on which of your bones are affected by Paget’s disease, you might have other symptoms and complications, such as those listed below.

Symptoms associated with Paget’s disease

Although rare, the most serious complication of Paget’s disease is bone cancer.

Can Paget’s Disease be treated?

Yes, Paget’s disease can be treated. Finding and treating Paget’s disease early is best to prevent complications. The U.S. Food and Drug Administration has approved several drugs to treat the disease. Doctors most often prescribe drugs called bisphosphonates. These help reduce bone pain and stop or slow down the progress of the disease.

Will these drugs also help improve the complications I have from Paget’s disease?

The drugs may help prevent complications from starting or prevent them from getting worse, but they cannot correct problems that have already set in. In some cases, surgery can help. Your doctor can tell you if surgery might be a good idea for you.

How will the doctor know if the drug I take is working?

Your doctor will probably monitor your progress using two tests: an x-ray of your bones and a blood test to measure the level of a chemical called serum alkaline phosphatase (SAP) in your blood. The x-rays will show your doctor pictures of how your bones are healing. A decrease in the amount of SAP in your blood will tell your doctor that the disease is less active and you are getting better.

Is there a special diet I should follow?

There is no special diet to prevent or help treat Paget’s disease. For overall bone health, you should eat a balanced diet rich in calcium and vitamin D. The Institute of Medicine (IOM) of the National Academy of Sciences recommends 1,000 mg (milligrams) of calcium daily for adults age 19 to 50. Women over age 50 and men over age 70 should increase their intake to 1,200 mg daily. To help your body use the calcium, the IOM recommends 600 International Units (IU) of vitamin D up to age 70 and 800 IU after 70.

What about exercise? Can I still be active?

Exercise is important for people with Paget’s disease. Being active can help you maintain healthy bones, control your weight, and keep your joints moving. But, you should talk with your doctor before starting an exercise program to make sure what you plan to do is safe and will not put too much stress on the bones that are affected by Paget’s disease. For example, your doctor might advise you to try walking instead of jogging if you have Paget’s disease in your legs.

Do I need to see a special doctor? What kinds of doctors specialize in this disease?

The doctor who diagnosed your Paget’s disease may be a specialist in the disease. If not, he or she can refer you to someone who is. Doctors who are the most experienced in treating patients with Paget’s disease are:

• Endocrinologists, who treat hormonal and metabolic disorders.
• Rheumatologists, who treat joint and muscle disorders.

Sometimes other doctors may be needed, such as orthopaedists; neurologists; and ear, nose, and throat specialists. Your doctor will help you find the specialists you need.

Will my children get this disease, too?

Paget’s disease does not always run in families; however, research suggests that a close relative of someone with Paget’s disease is more likely to develop the disease than someone without an affected relative. Finding and treating Paget’s disease early is important, so a doctor may recommend that children and siblings of a person with Paget’s disease be tested for the disease.

To screen for Paget’s disease, a doctor uses the SAP test. If the SAP level is high, suggesting that there might be Paget’s disease, the doctor can perform a test called a bone scan to learn which bones may be affected. The doctor will typically order an x-ray of the affected bones to make sure the diagnosis of Paget’s disease is correct.

Certain factors may increase your risk for Paget’s disease:

• Age. Paget’s disease is uncommon in people under age 40, and the chance of developing the disease increases as you age.
• Anglo-Saxon descent. Paget’s disease is more common in certain geographical areas, including North America, Australia, New Zealand, and Europe in people of Anglo-Saxon descent. It is not common in Asia, Africa, and Scandinavia.
• Family history. Paget’s disease commonly occurs in families.

Studies show that men may be slightly more likely than women to have the disease.

A combination of genetic and environmental factors likely play a role in causing Paget disease of bone. Researchers have identified changes in several genes that increase the risk of the disorder. Other factors, including infections with certain viruses, may be involved in triggering the disease in people who are at risk. However, the influence of genetic and environmental factors on the development of Paget disease of bone remains unclear.

Researchers have identified variations in three genes that are associated with Paget disease of bone: SQSTM1, TNFRSF11A, and TNFRSF11B. Mutations in the SQSTM1 gene are the most common genetic cause of classic Paget disease of bone, accounting for 10 to 50 percent of cases that run in families and 5 to 30 percent of cases in which there is no family history of the disease. Variations in the TNFRSF11B gene also appear to increase the risk of the classic form of the disorder, particularly in women. TNFRSF11A mutations cause the early-onset form of Paget disease of bone.

The SQSTM1, TNFRSF11A, and TNFRSF11B genes are involved in bone remodeling, a normal process in which old bone is broken down and new bone is created to replace it. Bones are constantly being remodeled, and the process is carefully controlled to ensure that bones stay strong and healthy. Paget disease of bone disrupts the bone remodeling process. Affected bone is broken down abnormally and then replaced much faster than usual. When the new bone tissue grows, it is larger, weaker, and less organized than normal bone. It is unclear why these problems with bone remodeling affect some bones but not others in people with this disease.

Researchers are looking for additional genes that may influence a person's chances of developing Paget disease of bone. Studies suggest that genetic variations in certain regions of chromosome 2, chromosome 5, and chromosome 10 appear to contribute to disease risk. However, the associated genes on these chromosomes have not been identified.

Normal Function

The SQSTM1 gene provides instructions for making a protein called p62. This protein plays an important role in bone remodeling, a normal process in which old bone is broken down and new bone is created to replace it. The p62 protein helps regulate this process through its role in a chemical signaling pathway that promotes the formation of osteoclasts. Osteoclasts are specialized cells that break down bone tissue during bone remodeling.

Studies suggest that p62 may have other functions in addition to its role in bone remodeling. It may be involved in recycling worn-out cell parts and unneeded proteins (autophagy), the self-destruction of cells (apoptosis), and the body's immune responses and inflammatory reactions.

Health Conditions Related to Genetic Changes

Paget disease of bone

More than 20 mutations in the SQSTM1 gene have been found to cause Paget disease of bone. Many SQSTM1 gene mutations change single protein building blocks (amino acids) in the p62 protein. The most common mutation replaces the amino acid proline with the amino acid leucine at protein position 392 (written as Pro392Leu or P392L).

Through a mechanism that is not well understood, SQSTM1 gene mutations appear to overactivate the chemical signaling pathway that promotes osteoclast formation. The increased signaling stimulates the production of too many osteoclasts and triggers these cells to break down bone abnormally. In people with Paget disease of bone, affected bone is broken down and replaced much faster than usual. When the new bone tissue grows, it is weaker and less organized than normal bone. These problems with bone remodeling cause certain bones to become unusually large, misshapen, and easily broken (fractured). It is unclear why the disease affects some bones but not others.

Amyotrophic lateral sclerosis

MedlinePlus Genetics provides information about Amyotrophic lateral sclerosis

Other Names for This Gene

• A170
• EBI3-associated protein p60
• OSIL
• oxidative stress induced like
• p60
• p62
• p62B
• PDB3
• phosphotyrosine independent ligand for the Lck SH2 domain p62
• SQSTM_HUMAN
• ubiquitin-binding protein p62
• ZIP3

Genomic Location

Normal Function

The TNFRSF11A gene provides instructions for making a protein called receptor activator of NF-κB (RANK). This protein plays an important role in bone remodeling, a normal process in which old bone is broken down and new bone is created to replace it. During bone remodeling, RANK helps direct the formation and function of specialized cells called osteoclasts, which break down bone tissue. RANK is located on the surface of immature osteoclasts, where it receives signals that trigger these cells to mature and become fully functional.

Health Conditions Related to Genetic Changes

Osteopetrosis

MedlinePlus Genetics provides information about Osteopetrosis

Paget disease of bone

At least two very similar mutations in the TNFRSF11A gene have been found to cause the rare, early-onset form of Paget disease of bone. Both mutations are duplications, which means that they abnormally copy a segment of genetic material within the gene. Each of these mutations results in the production of a RANK protein that contains several extra protein building blocks (amino acids).

Through a mechanism that is not well understood, duplication mutations in the TNFRSF11A gene appear to overactivate the chemical signaling pathway that promotes osteoclast formation. The increased signaling stimulates the production of too many osteoclasts and triggers these cells to break down bone abnormally. In people with early-onset Paget disease of bone, affected bone is broken down and replaced much faster than usual. When the new bone tissue grows, it is weaker and less organized than normal bone. These problems with bone remodeling cause certain bones to become unusually large, misshapen, and easily broken (fractured).

Other disorders

Mutations in the TNFRSF11A gene are responsible for several other rare bone diseases, including two very similar disorders called familial expansile osteolysis (FEO) and expansile skeletal hyperphosphatasia (ESH). These disorders have signs and symptoms that overlap with those of early-onset Paget disease of bone. In fact, some researchers believe that FEO, ESH, and early-onset Paget disease of bone actually may be slightly different forms of a single condition. FEO and ESH both appear early in life and are characterized by skeletal abnormalities, tooth loss, and progressive hearing loss.

Like early-onset Paget disease of bone, FEO and ESH result from duplication mutations in the TNFRSF11A gene. Studies suggest that these mutations overactivate RANK, leading it to stimulate the production of too many osteoclasts and trigger these cells to break down bone abnormally. The resulting imbalance in bone remodeling causes the major features of these disorders. It is unclear why duplication mutations in the TNFRSF11A gene can cause several different bone diseases.

TNFRSF11A gene mutations also cause a bone disease called autosomal recessive osteopetrosis (ARO). This disorder appears in infancy and is characterized by abnormally dense bones. The increased bone density leads to a variety of complications, including an increased risk of fractures, vision impairment, hearing loss, and problems with the immune system related to defective bone marrow. Mutations in the TNFRSF11A gene appear to be a very rare cause of ARO; fewer than 10 mutations have been found in affected individuals. Most of these mutations change single amino acids in the RANK protein, which prevents it from receiving signals on the surface of immature osteoclasts. As a result, people with this condition have a total absence of mature, functional osteoclasts. Without these specialized cells to break down bone tissue, excess bone is formed throughout the skeleton.

Other Names for This Gene

• CD265
• FEO
• ODFR
• OFE
• OPTB7
• osteoclast differentiation factor receptor
• OSTS
• PDB2
• RANK
• receptor activator of NF-kappa-B
• receptor activator of nuclear factor-kappa B
• TNR11_HUMAN
• TRANCER
• tumor necrosis factor receptor superfamily member 11a
• tumor necrosis factor receptor superfamily member 11a, NFKB activator
• tumor necrosis factor receptor superfamily, member 11a
• tumor necrosis factor receptor superfamily, member 11a, activator of NFKB
• tumor necrosis factor receptor superfamily, member 11a, NFKB activator

Genomic Location

Normal Function

The TNFRSF11B gene provides instructions for making a protein called osteoprotegerin. This protein plays an important role in bone remodeling, a normal process in which old bone is broken down and new bone is created to replace it. Osteoprotegerin is involved in the regulation of specialized cells called osteoclasts, which break down bone tissue during bone remodeling.

Osteoprotegerin is one of two receptor proteins that can attach (bind) to a protein called receptor activator of NF-κB ligand (RANKL). The other receptor protein is called receptor activator of NF-κB (RANK). Because RANKL can only bind to one receptor at a time, osteoprotegerin and RANK compete with one another. When RANKL is bound to RANK, it sets off a series of chemical signals that trigger immature osteoclasts to mature and become fully functional. When RANKL is bound to osteoprotegerin, it blocks these chemical signals and prevents the activation of osteoclasts. Because no chemical signals are transmitted when RANKL is attached to osteoprotegerin, osteoprotegerin is often called a "decoy" receptor.

By reducing the amount of RANKL that is available to bind to RANK, osteoprotegerin plays a critical role in regulating the process of bone remodeling.

Health Conditions Related to Genetic Changes

Paget disease of bone

Studies suggest that several normal variations (polymorphisms) in the TNFRSF11B gene may increase the risk of developing classic Paget disease of bone, particularly in women. These genetic changes could affect the amount or function of osteoprotegerin. However, it is unclear how polymorphisms in this gene influence disease risk.

Juvenile Paget disease

At least six mutations in the TNFRSF11B gene have been found to cause juvenile Paget disease. Each of these mutations greatly reduces the function of osteoprotegerin or prevents cells from making any of this protein. Without osteoprotegerin, RANKL binds only to RANK. The resulting increase in chemical signaling stimulates the production of too many osteoclasts and triggers these cells to break down bone abnormally. In people with juvenile Paget disease, bone is broken down and replaced much faster than usual. When the new bone tissue grows, it is weaker and less organized than normal bone. These problems with bone remodeling cause bones throughout the skeleton to become unusually large, misshapen, and easily broken (fractured).

Other Names for This Gene

• MGC29565
• OCIF
• OPG
• osteoclastogenesis inhibitory factor
• osteoprotegerin
• osteoprotegerin precursor
• TR1
• TR11B_HUMAN
• tumor necrosis factor receptor superfamily member 11b
• tumor necrosis factor receptor superfamily, member 11b

Genomic Location

In 15 to 40 percent of all cases of classic Paget disease of bone, the disorder has an autosomal dominant pattern of inheritance. Autosomal dominant inheritance means that having one copy of an altered gene in each cell is sufficient to cause the disorder.

In the remaining cases, the inheritance pattern of classic Paget disease of bone is unclear. Many affected people have no family history of the disease, although it sometimes clusters in families. Studies suggest that close relatives of people with classic Paget disease of bone are 7 to 10 times more likely to develop the disease than people without an affected relative.

Early-onset Paget disease of bone is inherited in an autosomal dominant pattern. In people with this form of the disorder, having one altered copy of the TNFRSF11A gene in each cell is sufficient to cause the disease.

You may not know you have Paget’s disease because many people with the disease do not have symptoms. However, fractures or misshapen bones can develop and cause pain. Sometimes, this bone pain, which is the most common symptom of the disease, is mistaken for arthritis or other disorders. Generally, symptoms develop slowly, and the disease does not spread to normal bones.

Paget’s disease can affect any bone, but usually occurs in:

• Spine.
• Pelvis.
• Femur and Tibia (leg bones).
• Skull.

In addition, some people with advanced disease may have misshapen bones and other bone changes, which may include:

• Increase in head size.
• Bow shape of a limb.
• Curvature of the spine.

Other symptoms can develop, depending on the bone affected and can include:

• Headaches and hearing loss when Paget’s disease affects the skull.
• Tingling and numbness in arms and legs when enlarged vertebrae put pressure on the nerves in the spine.
• Hip pain, which may occur when Paget’s disease affects the pelvis or thighbone.

Depending on the bone or bones affected by Paget’s disease, other medical problems can develop, such as:

• Damage to joint cartilage can lead to arthritis.
• Changes in the bones of the skull and ear can lead to hearing loss.
• For some people who have heart disease already and severe Paget’s disease, the extra workload of pumping blood throughout the body can lead to heart failure.
• Enlarged bones in the skull and spine can lead to pressure on the brain, spinal cord, or nerves and reduced blood flow to the brain and spinal cord.
• When Paget’s disease affects the facial bones, the teeth may loosen. This may make chewing more difficult.
• Rarely, people with Paget’s disease can develop bone cancer.

Many people with Paget’s disease are diagnosed after having tests for other conditions or to help diagnose the cause for their pain. Some common tests used to diagnose Paget’s disease include:

• X-ray. This is the most common test that doctors use to diagnose the disease. An x-ray can evaluate the bone structure for Paget’s disease.
• Blood test. Your doctor may order a blood test to check for the enzyme alkaline phosphatase. This test can indicate either Paget’s disease or another condition such as liver disease. If your blood contains high levels of the enzyme, it may be a sign of the disease.
• Bone scan. A bone scan is a test that helps doctors identify which bones are affected by Paget’s disease. The test may help your doctor understand the extent of the disease. During a bone scan, a safe amount of radioactive substance is injected into a vein in your arm. The substance circulates through the bloodstream and “highlights” places in your skeleton where Paget’s disease may be present by collecting in areas where there is increased blood flow and activity of bone-forming cells characteristic of Paget’s disease.

If you do not have symptoms, you may not need treatment. However, if your disease is active, you have symptoms, or you have a higher chance of developing complications, your doctor may recommend treatment. The goal of your treatment is to:

• Slow down or stop bone breakdown and formation.
• Lower the risk of complications.
• Ease bone and joint pain.
• Repair fractures.
• Correct bone deformity

Doctors can recommend several options to help treat Paget’s disease, prevent complications of the disease and promote bone health, including:

• Medications.
• Surgery.
• Exercise.
• Diet.

Treatment can help you manage your symptoms but does not cure the disease.

Medications

The primary medications your doctor may prescribe to treat Paget’s disease include:

• Bisphosphonates, which treat a variety of bone diseases. This type of medication works by controlling the excessive breakdown and formation of bone that happens in Paget’s disease.
• Calcitonin, which is a hormone made by the thyroid gland. In addition, calcitonin regulates blood levels of calcium and phosphate and promotes the formation of new bone.

Surgery

Although medications can regulate bone growth and minimize complications, surgery may be necessary to correct problems from the complications of the disease, such as:

• Fractures. Surgery may allow fractures or broken bones to heal in a better position.
• Arthritis. A hip or knee replacement may be necessary if changes in the bones cause severe disability.
• Misshapen bones. Cutting and realigning bone affected by Paget’s disease can reduce pain in a weight-bearing joint.

Diet

If you have Paget’s disease, you do not need a special diet. However, it is important that you keep your bones strong. Calcium and vitamin D are important nutrients to help maintain healthy bone. The chart below shows how much calcium and vitamin D you need each day. If you have had kidney stones, talk with your doctor about how much calcium and vitamin D to take.

Exercise

Exercise is important because it helps:

• Build strong bones and maintain your skeletal health.
• Prevent weight gain.
• Keep joints mobile.

The best exercises for healthy bones are strength-building and weight-bearing exercises, such as:

• Walking.
• Climbing stairs.
• Lifting weights.

Before starting a new exercise plan, talk with your doctor to avoid stress on bones affected by Paget’s disease.

Paget’s disease can affect many parts of the body. You may need to see more than one type of doctor, including:

• Endocrinologists, who treat hormonal and metabolic disorders.
• Rheumatologists, who treat joint and muscle disorders.
• Neurologists, who treat disorders and diseases of the spine, brain, and nerves.
• Orthopaedic surgeons, who treat bone injuries and disease.
• Otolaryngologists, who treat ear, nose, and throat disorders.

Fortunately, current treatments can help most people with Paget’s disease lead productive lives. When you follow your doctor’s treatment plan, you may lower the chance of developing complications or major changes in your bones. You should also:

• Maintain a healthy weight, which is particularly important if Paget’s disease has led to arthritis of the weight-bearing joints, such as the hip or knee. Excess weight can mean more stress – and pain – for affected joints.
• Prevent falls by:
  • Checking your home for dangers such as loose rugs and poor lighting.
  • Installing grab bars and handrails.
  • Using nonskid mats in the bathroom and tub.
  • Having regular eye exams.
  • Increasing your balance and strength by exercising every day.
• Live a healthy lifestyle to maintain good bone health. Do not smoke, and if you do smoke, quit. If you choose to drink alcohol, do so in moderation. It is best to have no more than one drink a day for women and no more than two drinks a day for men.