Paget disease of bone

Paget disease of bone, chronic disease of middle age, characterized by excessive breakdown and formation of bone tissue. It is a localized disease that may be unifocal, affecting a single bone, or multifocal, affecting many bones or nearly the entire skeleton. For this reason, it is included among the metabolic bone diseases. The disease is named for the English surgeon and pathologist Sir James Paget, who first described it.

Paget disease of bone is common among people of northern European descent, and it is almost nonexistent among people of Asian and African descent. The disease is characterized by excessive bone resorption, which is mediated by osteoclasts (cells that dissolve and absorb bone), and by excessive bone formation, which is mediated by osteoblasts (cells that synthesize bone). When osteoclasts isolated from patients with Paget disease of bone are viewed through an electron microscope, structures that very closely resemble viruses can be seen. The osteoclasts are extraordinarily active, resorbing bone rapidly and, at the same time, activating a “coupling factor” that leads to an increase in bone formation by local osteoblasts. This increase may be both excessive and disorganized. The result is a “chaotic” bone structure, with areas of bone resorption and areas of excessive bone formation, which leads to bone weakening and bone deformities.

Paget disease of bone affects older women and men in approximately equal proportions, but men tend to have more advanced disease. Many patients are asymptomatic, and thus the bony abnormalities are detected by X-rays or by radionuclide bone scans that are done for other purposes. Some patients are found to have high serum concentrations of alkaline phosphatase, an enzyme involved in bone formation. Pain may occur in the affected bone or may be associated with bone overgrowth. For example, overgrowth of a bone of the skull or vertebrae may impinge on the spinal cord or nerves, causing a significant amount of pain. In addition, in the bone-destructive stages, bones soften and blood supply to the area increases, which may lead to heart or circulatory problems. In bone-constructive stages, bones are dense and brittle and fracture easily. The most common sites of the disease are the femur, pelvis, skull, and spine, but almost any bone may be affected. Patients with classic, advanced Paget disease of bone have a large skull, a shortened spine, and bowed thighs and legs, and pathological fractures and arthritis are common. In rare cases the disease is complicated by bone cancer.

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There is no known cure for Paget disease of bone. Treatment includes the administration of medications such as biphosphonates or calcitonin, which inhibit bone cell activity. Individuals with Paget disease of bone should also exercise regularly and receive adequate daily amounts of calcium and vitamin D.