Paget's Disease.
Last updated Monday, December 27, 2004
Management and treatmentTreatment With or without symptoms, if Paget's disease seems to be active, most doctors will prescribe treatment, usually focusing on on pain relief and prevention of bone deformities, fractures, hearing loss, and loss of mobility.
Health care team If Paget's disease affects your ability to do your daily activities,
your doctor may refer you to an occupational or physical therapist. For
examples if bowing of a leg bone interferes with walking, a shoe lift
may help. Canes may also help. Your doctor or a physical therapist can
give you an exercise program that will help you maintain flexibility and strength. If your hearing has been affected, a special hearing aid may help.Diet A healthy diet
can help a person with Paget's disease maintain normal weight. Extra
weight can put too much stress on certain bones or joints that already
are weak from Paget's disease.Medications Aspirin, other nonsteroidal anti-inflammatory medications (NSAIDs),
and non-narcotic analgesics (pain relievers) help reduce pain that
might be associated with Paget's disease. Anti-Pagetic treatment
includes medications that slow down or block the rate of bone breakdown
and formation. Medications most often prescribed include calcitonin S
(calcimar, Miacalcin, or Cibacalcin) or bisphosphonates (Didronel). A
third medication, plicamycin (Mithracin)--previously called
mithramycin--is prescribed in rare instances where there is serious and
extensive disease activity.
Calcitonin is a natural hormone that reduces the breakdown of
bone. Calcitonin must be injected to be used as a treatment (a person
can learn self-injection). Initial treatment usually involves a daily
injection, but over time some people find that two or three injections
per week are sufficient. Improvement of some symptoms may be seen
within the first two weeks to two months. However, it often takes three
to six months to see evidence of the anti-Pagetic effects.
Bisphosphonates, especially etidronate (Didronel), are oral
medications that slow down both the breakdown and formation of bone.
Etidronate is best absorbed when the stomach is empty. (Don't take the
tablets with milk, vitamins, or calcium, all of which may block
absorption.) Etidronate should never be used longer than six months at
a time and is most effective when the person waits another six months
before resuming the medication.
Other, newer bisphosphonates are being studied. A new
bisphosphonate--pamidronate (Aredia)--has been approved by the U.S.
Food and Drug Administration for use in treating other calcium
disorders in an intravenous form, but specialists in the field of
Paget's disease are also occasionally using it for that condition as
well.
Plicamycin is administered by intravenous injection.
Plicamycin can slow down the activity of cells that make and remove
bone in Paget's disease. Because the drug can produce serious side
effects to bone marrow, the liver, and the kidneys, its use in Paget's
disease is still quite limited.
Each of these medications requires close supervision by a
doctor and must be taken exactly as prescribed. Regular blood and urine
tests are required to determine whether or not the medication is
producing the desired effect.
Surgery For some people who have Paget's disease near the hip or knee joint, joint replacement surgery
can help to relieve pain and improve function. In some situations,
surgery may also help correct leg or thigh bowing or hearing loss due
to Paget's disease.
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