Paget’s: The neglected bone disease

SummaryAfter osteoporosis, Paget’s disease is the next most common metabolic bone disease in the UK where it occurs in approximately 2% of adults over the age of 55, rising to 8% of men and 5% of women by the eighth decade of life. Patients with this disease are managed in varied clinical settings including orthopaedics with some complaining about lack of awareness amongst health professionals, with delays in diagnosis and starting appropriate treatment being the major problems. Paget’s disease which is characterised by focal increases in bone turnover affects one or multiple bones in the skeleton and occurs most commonly in the skull, spine, hip and pelvis. Whilst many people have few symptoms in others it can result in pain at the affected site, marked bone deformity, deafness, neurological symptoms, pathological fractures and may be associated with an increased risk of developing osteoarthritis. Both viral and genetic factors have been implicated in the causation of Paget’s disease with most recent research tending to favour genetic causation. At present Paget’s disease cannot be cured, but early recognition and treatment with either oral or intravenous bisphosphonates will help to control its progress and minimise complications. On occasions however a small number of patients will require surgery, commonly for joint replacement, fracture fixation and correction of bone deformities.