Treating Paget’s disease
Not everyone with Paget’s disease will require treatment. If treatment is needed, medication is most often used.
If a blood test reveals you have Paget’s disease but you are not experiencing symptoms, a policy of “watchful waiting” is likely to be recommended. This means you will not receive treatment immediately, but your progress will be carefully monitored using regular blood tests.
Treatment is usually recommended if you have symptoms such as bone pain or pain, numbness and tingling.
Treatment cannot cure Paget’s disease, but it can relieve symptoms and prevent the condition from 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 remodelling
- medication to relieve pain
- physical therapy
- surgery
Regulating bone remodelling
There are a number of different medications used to help regulate bone growth in cases of Paget’s disease.
If you are 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 has proved to be effective in treating Paget’s disease and is usually recommened. Risedronate is available in tablet form and most people are advised to take one tablet a day over the course of a two-month period.
Take your risedronate tablet while you are 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 are unable to take risedronate because you are 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.
Zoledronic acid 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 is unsafe to take bisphosphonates safely 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 is given by injection once a day. The recommended course will depend on how well you respond to treatment, although it usually lasts between six 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.
Physical therapy
Some people with Paget’s disease find they benefit from physiotherapy or occupational therapy, particularly those who have had fractures or other types of damage in the bones of their legs or spine.
There are devices designed to reduce the weight placed on 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 that can:
- 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 problem, 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:
- an arthroplasty – where the damaged joint is removed and replaced with an artificial joint: the most commonly performed arthoplasties 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.
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