Paget's disease - Treating Paget's disease

Paget's disease doesn't always require treatment. If treatment is needed, there are several options to help relieve symptoms.

If a blood test reveals you have Paget's disease but you're not experiencing any symptoms, you probably won't receive treatment immediately.

Instead, your progress can be carefully monitored with regular blood tests, known as "watchful waiting".

Treatment is usually recommended if you have symptoms such as bone pain, or pain, numbness and tingling.

Treatment can't cure Paget's disease, but it can relieve symptoms and prevent the condition getting worse. Treatment also reduces your chances of developing any complications of Paget's disease.

Treatments for Paget's disease include:

• medication to help regulate bone growth
• medication to relieve pain
• physical therapy
• surgery

Regulating bone growth

There are a number of different medications used to help regulate bone growth in cases of Paget's disease.

If you're being treated with one of these medicines, you may have regular blood tests or X-rays to check they are working.

Bisphosphonates

Bisphosphonates are the first-choice treatment to regulate bone growth. They work by controlling the cells that absorb old bone (osteoclast cells), which means the bone regeneration process should return to normal.

A type of bisphosphonate called risedronate is usually recommended. Risedronate is available in tablet form. Most people are advised to take one tablet a day over the course of a two-month period.

Take your risedronate tablet while you're standing or sitting up, and avoid lying down for at least 30 minutes after taking it. This will help prevent heartburn (burning chest pain and discomfort).

Side effects of risedronate include:

• feeling sick
• stomach pain
• constipation
• bloating
• diarrhoea

If you're unable to take risedronate because you're unable to stay upright for 30 minutes, there are alternative bisphosphonates, such as pamidronate. Pamidronate is given by injection, usually once a week over the course of six weeks.

The most common side effects of pamidronate include:

• mild flu-like symptoms, such as a high temperature
• joint pain
• headaches
• chills

However, these side effects usually pass within 48 hours of receiving an injection.

Zoledronic acid

Zoledronic acid, also called zoledronate, is a newer type of bisphosphonate increasingly being used as an alternative to risedronate or pamidronate.

It is given as an injection and its effects can last a long time. You may only need an injection once every two years.

Flu-like symptoms, such as chills, fever and joint pain, are common after receiving your first injection, although these side effects should pass within three to four days.

Calcitonin

Calcitonin used to be a common treatment for Paget's disease, but is only used in certain circumstances now.

If you have low levels of calcium in your blood (hypocalcaemia), it's unsafe to take bisphosphonates because they can lower your calcium levels further.

In these circumstances, an alternative medication called calcitonin may be recommended. Calcitonin is a man-made version of a hormone known to prevent bone loss. It's given by injection once a day.

The recommended course will depend on how well you respond to treatment, although it usually lasts between 6 and 18 months.

Common side effects of calcitonin include:

• changes in how things taste
• nausea
• abdominal pain
• diarrhoea
• fatigue
• dizziness

Painkillers

In most cases, painkillers available over the counter, such as paracetamol or ibuprofen, should relieve the symptoms of bone pain. If your symptoms continue, your GP can prescribe more powerful painkillers.

Dietary supplements

If you have Paget's disease, your GP may recommend taking regular calcium supplements. Both of these help strengthen your bones.

Some medications for Paget's disease can also reduce the levels of calcium in your body, so you may need to "top up" your levels by taking supplements.

Physical therapy

Some people with Paget's disease find they benefit from physiotherapy or occupational therapy, particularly people with fractures or other types of damage in the bones of their legs or spine.

There are devices available that are designed to reduce the weight placed on the affected bones, which should help reduce pain and make everyday physical activities easier. Examples include:

• walking devices – such as a cane or walking frame
• orthotics – insoles made of plastic that fit inside your shoe to help support your feet
• spine braces – designed to support the spine in the correct position

Some therapists also use different types of energy, such as electric currents or impulses, to stimulate the nervous system (energy-based therapy). The electric impulses are thought to ease pain and promote healing in some people.

The therapist will also be able to teach you a number of exercises to:

• improve your muscle strength
• maintain the range of movement and flexibility in your joints
• increase your physical stamina

Read about physiotherapy and occupational therapy for more information and advice.

Surgery

Surgery is usually only used if Paget's disease causes further problems, such as bone fractures.

If you develop a fracture, surgery may be required to realign the bones so the affected bone is able to heal properly.

If you experience severe osteoarthritis, surgery may be required to repair or replace a damaged joint. Surgical options for osteoarthritis include:

• arthroplasty – where the damaged joint is removed and replaced with an artificial joint; the most commonly performed arthroplasties are hip replacements and knee replacements
• arthrodesis – where the joint is fused into a permanent position

Surgery may also be used if you develop bone deformities. A procedure called an osteotomy involves carefully cutting the affected bone so it can be straightened. This operation is usually carried out under general anaesthetic, so you will not experience any pain.