Published: 18 Jun 2025

ICD9: 731.0      ICD10: M88.89      ICD11: FB85

Paget's disease of bone is a chronic disorder that disrupts the normal cycle of bone renewal, causing bones to become enlarged, deformed, and weakened.
In healthy bones, old bone tissue is broken down and replaced with new bone tissue. In Paget's disease, this process is disrupted, leading to:

Excessive bone breakdown (resorption): Bones are broken down faster than normal.
Rapid and disordered bone formation: The body tries to rebuild the bone too quickly, but the new bone is often larger, weaker, and more prone to fracture.

This abnormal bone remodeling can affect any bone in the body, but it most commonly occurs in the pelvis, skull, spine, and legs.

Here's a breakdown of key aspects of Paget's disease:

Causes:

The exact cause isn't fully understood, but it is believed to be a combination of genetic and environmental factors.
Researchers suspect a viral infection early in life may play a role in people who have a genetic predisposition to the disease.

Symptoms:

Many people have no symptoms. In these cases, the disease may be discovered during an X-ray or blood test done for another reason.
When symptoms do occur, they can include:
Bone pain: This is the most common symptom. It can be constant, aching, or sharp and stabbing.
Bone deformities: Affected bones may become enlarged or curved. For example, the legs may bow.
Fractures: Weakened bones are more likely to break.
Arthritis: Paget's disease can cause osteoarthritis in joints near affected bones.
Hearing loss: If the skull bones are affected, it can lead to hearing problems.
Headaches: Skull involvement can also cause headaches.
Enlarged head: The skull may gradually enlarge, leading to the need for larger hats.
Nerve compression: Overgrowth of bone can compress nerves, leading to pain, numbness, or tingling.
Increased warmth over the affected bone: Due to increased blood flow.

Diagnosis:

X-rays: These can show characteristic changes in bone structure.
Bone scan: This imaging test can show which bones are affected.
Blood tests: Elevated levels of alkaline phosphatase in the blood can indicate Paget's disease.

Treatment:

Medications (Bisphosphonates): These are the primary treatment for Paget's disease. They help to slow down bone breakdown and normalize bone turnover.
Pain relievers: Over-the-counter or prescription pain medications can help manage pain.
Surgery: Surgery may be needed to correct bone deformities, repair fractures, or relieve nerve compression.
Physical therapy: This can help improve muscle strength, flexibility, and balance.

Complications:

Bone fractures
Osteoarthritis
Hearing loss
Nerve compression
Heart failure: Increased blood flow to affected bones can strain the heart.
Osteosarcoma: In rare cases, Paget's disease can lead to bone cancer.
Hypercalcemia: Abnormally high levels of calcium in the blood.

Who is at risk?

Age: Paget's disease is most common in people over the age of 50.
Family history: Having a family member with Paget's disease increases your risk.
Geographic location: The disease is more common in people of British descent and in certain parts of Europe.

In summary, Paget's disease of bone is a chronic condition that disrupts normal bone remodeling, leading to enlarged, deformed, and weakened bones. While many people have no symptoms, those who do may experience bone pain, deformities, and fractures. Treatment with medications can help control the disease and reduce the risk of complications.

It is important to note that if you suspect you have Paget's disease, you should consult a doctor for proper diagnosis and treatment. This information should not be used as a substitute for professional medical advice.