Paget's Disease

Paget's Disease (Osteitis deformans) See Paget Disease 2006

Cause: Unknown.

Paget's disease is a resorptive disease of bone that affects more than 3% of persons more than 40 years of age. Men predominate, and the disease is often asymptomatic, first detected roentgenographically. Localized regions of both bone resorption and reactive sclerosis are characteristic. There is a high rate of bone turnover, with increased levels of serum alkaline phosphatase.

DX:
X-ray of the bone, increased alkaline phosphatase & urin. hydroxyproline oxidase (markers of disease activity).

SX:
The most common symptom is pain, often worsened by weight-bearing activities. Vertigo and hearing loss may occur if there is bony impingement on the eighth nerve. Advanced disease is associated with bony deformity, particularly of the calvaria, and with fractures. There is an increased risk of both benign giant cell tumors and of osteogenic sarcoma.

RX:
Both calcitonin and bisphosphonates have been used successfully to treat symptomatic Paget's disease. The safety, efficacy, and lower cost of bisphosphonates make them the current therapy of first choice.

Calcitonin
Injection - Calcimar 200 units/mL (2 mL) Give 100 units/day IM or SQ
(Test dose 1 unit/0.1mL intracutaneously)
Spray or nasal - (Miacalcin) 200 units/activation daily, alternating nostrils daily.

Biphosphanates
Fosamax/Alendronate-Na 40 mg tab 1/day for 6 months