* IS THE SECOND MOST COMMON BONE DISORDER IN ELDERLY AFTER OSTEOPOROSIS.
PREVALENT DISORDERS : ARTHRITIS, FRACTURES, PRIMARY HYPERPARATHYROIDISM, OSTEOPOROSIS, THYROID DISEASE, RENAL STONE & MALIGNANT SARCOMA IN PAGETIC BONE.
Medical Care:
" The short-term objective of treatment is to control disease activity. The long-term objectives of treatment are to minimize or prevent disease progression and to decrease complications from the disease, if possible.
" Indications for treatment include complications of Paget disease, including bone pain, progressive skeletal deformity, high-output congestive heart failure, hypercalcemia, compression of spinal cord and nerve roots, bone compression of the eighth cranial or optic nerve, recurrent renal calculi due to hypercalciuria, or fractures. When Paget disease occurs around a joint, treatment is often administered in an attempt to prevent development of osteoarthritis. Also, young patients and those with high levels of BSAP are often treated to avoid future complications.
" Medical therapy for Paget disease should include bisphosphonate treatment with serial monitoring of bone markers. Bone markers should be rechecked 2-3 months following bisphosphonate treatment.
" Because of the increased risk of malignancy, patients should be monitored indefinitely.
" Nonsteroidal anti-inflammatory drugs and acetaminophen may be effective for pain management.
" Orthotic devices, including canes and walkers, may be useful for patients with Paget disease that involves the lower limbs who have gait abnormalities.
" Chemotherapy, radiation, or both may be used to treat neoplasms arising from pagetic bone.
Surgical Care:
" Indications for surgery are bony deformity, pathologic fractures, nerve compression, and degenerative arthritis, particularly of the hip or knee.
" Total hip replacement and tibial osteotomy are effective for relieving pain and restoring mobility. Pharmacological therapy, including bisphosphonates, should be used preoperatively to try to reduce disease activity in order to prevent severe blood loss during surgery.
" After surgery, bone healing may be prolonged, and lengthy rehabilitation may be necessary.
" Amputation may also be necessary in the presence of a malignant transformation.
" Decompressive laminectomies may be necessary if medical therapy cannot induce recovery in those with neurological sequelae from spinal cord compression.
Diet:
" No specific dietary modifications are necessary in patients with Paget disease. However, in patients with Paget disease who are receiving bisphosphonate therapy, ensure adequate intake of calcium and vitamin D.
Activity:
" No specific adjustments in physical activity levels are necessary in patients with Paget disease. If secondary osteoarthritis occurs in the knee, quadriceps-strengthening exercises may be helpful. If bone pain occurs with weight bearing or if gait abnormalities are present, individualized adjustment in physical activity regimens may be necessary.
DRUG TREATMENT :
1. BISPHOSPHONATES : TO REDUCE EXCESS BONE TURNOVER
2. CALCITONIN