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Paget's disease of bone is an inflammatory condition of the skeleton which disturbs skeletal metabolism and can cause bone
pain, deformities, and fractures. It is second to osteoporosis in frequency and there are more than a million cases in the United States, mostly in older persons. Of these, 250,000 patients have sufficient
involvement to need treatment, but only a quarter of these are being treated despite the development of excellent drug therapy over the past several years. Injectable calcitonin was the first drug found to be
effective but now there are a number of oral drugs, all among a class of drugs called bisphosphonates. Five of these are FDA approved: didronil, aredia, fosamax, skelid, and actonel (brand names).
Aredia is used intravenously and the rest are taken orally on an empty stomach. Newer bisphosphonate are being tested as brief intravenous treatments, short term and oral treatments and even as a skin patch, which
by-passes gastrointestinal problems which can occasionally develop during oral administration. Paget's disease presents in all degrees of severity,
ranging from asymptomatic involvement of one or a few non-strategic bones, to an extensive, disabling form. A least 25% of patients are symptomatic and in need of treatment. The major symptoms that bring
patients to medical attention are bone and joint pain, deformities, fractures, and neurologic abnormalities. The condition is diagnosed by the use of bone x-rays, bone scans, and blood tests. A major problem
in diagnosis is that the symptoms often masquerade as "arthritis" and proper testing is not ordered. Also, family members of patients with known Paget's disease are at greater risk of developing the condition, and
should be screened even if there are no relevant symptoms. To make an appointment with
a Rheumatologist, see our Patient Care section. |
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