What is Paget’s Disease (osteitis deformans)

Paget’s disease is a disorder of bone remodelling, resulting in enlarged and thickened bone that is structurally abnormal and brittle. This leads to bone pain, fractures, and deformities if untreated.

Statistics on Paget’s Disease (osteitis deformans)

Paget’s disease of bone is common, affecting up to 4% of Australians over the age of 55 years. In recent years, the incidence of Paget’s disease appears to be falling for unknown reasons.

Risk Factors for Paget’s Disease (osteitis deformans)

Paget’s disease is usually seen in people who are middle-aged or elderly. It is slightly more common in males than females.
It is more common in the United Kingdom, Australia, New Zealand and North America, perhaps reflecting the high numbers of British migrants to those areas. A gene predisposing to the development of Paget’s disease has been identified. Having a family history of Paget’s disease also increases risk.

Progression of Paget’s Disease (osteitis deformans)

There are several phases in the development of Paget’s disease:
1) There is an huge increase in bone resorption and bone turnover.
2) This is followed by increased production of bone which is poorly mineralised.
3) Bone deposition is disorganised, resulting in bone which is structurally weaker than normal bone, and hence at increased risk of fracture.

How is Paget’s Disease (osteitis deformans) Diagnosed?

Paget’s disease is usually diagnosed by x-ray of the affected bones. Bone scans are recommended for newly diagnosed patients to assess the extent of the disease, and the risk of developing further complications.

Prognosis of Paget’s Disease (osteitis deformans)

With effective treatment prognosis is good and long term remissions can be achieved. However, patients require regular blood tests and monitoring for development of complications or relapse of the disease.

How is Paget’s Disease (osteitis deformans) Treated?

May patients do not have any symptoms and do not need treatment. If treatment is indicated, medications called bisphosphonates are the treatment of choice. These help normalise bone turnover. Vitamin D and calcium supplements are given. An exercise program will help to maintain skeletal health.
Patients with Paget’s disease will require ongoing monitoring for their condition, in case of relapse or the development of complications.

Paget’s Disease (osteitis deformans) References

[1] Apley G. Concise system of orthopaedics and fractures. 2nd ed. 2001, Arnold
[2] Collier, Longmore, Scally. Oxford handbook of clinical specialties, 6th ed. 2003, Oxford University Press.
[3] Hosking, Meunier, Reginster, et al. Fortnightly Review: Paget’s disease of bone: diagnosis and management. BMJ 1996;312:491-494.
[4] Kumar and Clark. Clinical Medicine 5th ed. 2002. WB Saunders
[5] Schneider, Hofmann, Peterson. Diagnosis and Treatment of Paget’s Disease of Bone. Am F Phys 2002. (online) http://www.aafp.org/afp/20020515/2069.html
[6] Walsh J. Clinical Update: Paget’s disease of bone. MJA 2004; 181 (5): 262-265