Treatment Overview

Many people do not need any treatment for Paget's disease. But the disease should be monitored for the rest of your life because of increased risk of complications such as inflammation of joints (arthritis), broken bones (fractures), and nerve problems. If your disease is active, you should see your doctor every 3 months. See your doctor or nurse every 6 to 12 months if Paget's disease is inactive.

Doctors generally recommend treatment if you have symptoms or if you have no symptoms but are at risk of complications. You may be at risk if:

• Your lab tests suggest that your bone tissue is breaking down faster than normal.
• The disease is in long bones or bones that hold up the weight of the body (such as the thighbones or the spine). You may need treatment to prevent the affected bones from becoming brittle and breaking.
• The disease affects your skull or spine. You may need treatment for nerve problems such as dizziness, hearing loss, headaches, and numbness or tingling in the body. Paget's disease in these areas may also cause deformities (such as a bowed spine) that may make walking difficult. After bowing of bones has occurred, it cannot be reversed with medicine.
• You are having bone or joint surgery. If you have Paget's disease, you need treatment with medicines to slow bone growth before surgery to reduce the risk of problems such as bleeding after surgery.
• The disease requires you to stay in bed for a long time. You may need treatment to prevent levels of calcium in the blood from getting too high.

Doctors aim treatment at slowing the breakdown of bone tissue, which may help Paget's disease to become inactive. Treatment may also reduce pain and may help prevent complications.

If you have symptoms of complications from Paget's disease, such as painful joints, you may also need treatment for these conditions.

Initial treatment

For the initial treatment of Paget's disease, doctors usually prescribe a medicine called a bisphosphonate, which reduces the breakdown of bone tissue and helps control symptoms such as bone pain. This medicine may also help prevent complications such as osteoarthritis or nervous system problems. If you cannot tolerate bisphosphonate, your doctor may prescribe another medicine, called calcitonin.

Bisphosphonates nearly always make Paget's disease inactive, sometimes for years or decades. In some people, though, Paget's disease becomes active again. So you may need to take medicine off and on for the rest of your life.

If your bone pain does not go away while you are taking medicine to slow the breakdown of bone tissue, you may need acetaminophen, or aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs).

Other treatments may include the following:

• Splints or braces to support bones and joints can help prevent weakened bones from breaking. If your doctor prescribes a splint or brace, be sure it fits properly. Splints or braces that do not fit properly can cause skin irritation.
• Canes or walkers may help you walk with less risk of falling. Ask for training in how to use these devices properly. You can also use these reminders to help you use a cane or walker safely:
  • Using a cane
  • Using a walker
• Physical therapy can help strengthen muscles, increase endurance, and improve balance.
• Home health nursing may be right for you if you are taking a medicine that must be given intravenously. Home health nurses can also help make your home safe to prevent you from falling.
• Acupuncture and relaxation techniques (such as guided imagery and biofeedback techniques) may help reduce pain in some people.

You can help yourself at home by using these tips:

• Learn how to manage your pain, including using a pain diary.
• Take precautions to avoid falling, such as keeping floors clean and dry and removing clutter and throw rugs.
• Use weight-bearing exercises, such as walking, jogging, stair climbing, dancing, or lifting weights, to strengthen bones. Be sure that you do not place stress on bones affected by Paget's disease. Talk to your doctor or physical therapist about the best exercise program for your condition.
• Eat a nutritious diet, and be sure you are getting adequate amounts of calcium and vitamin D. Both are needed for building healthy, strong bones. Vitamin D helps bones absorb calcium and helps muscles get stronger.
• Use a hearing aid if you have hearing loss, or use a "white noise" machine or background music if ringing in your ears is a problem.

Ongoing treatment

If you are using bisphosphonate or calcitonin medicine and Paget's disease is still active, you may need to continue using it.

If the disease is now inactive, your doctor or nurse will monitor your condition with lab tests. Recommendations for these tests vary. Your doctor may order the tests every 3 months to once a year. Your checkups will probably continue for life. If pain returns, or if your lab tests show active Paget's disease, you will need to start taking medicine again. Your doctor will also look for complications, such as nervous system problems.

Bisphosphonates nearly always make Paget's disease inactive, sometimes for years or decades. In some people, though, Paget's disease becomes active again. You may need to take medicine off and on for the rest of your life.

Consider or continue using splints or braces to support your weakened bones. Be sure they fit properly.

Canes or walkers may help you walk with less risk of falling. You can use these reminders on how to use a cane or walker safely:

• Using a cane
• Using a walker

You may need physical therapy to help strengthen muscles, increase endurance, and improve balance.

Acupuncture and relaxation techniques (such as guided imagery and biofeedback) may help reduce your pain.

You may have home health nursing if you are taking a medicine that must be given intravenously. Home health nurses can also help make your home safe to prevent you from falling.

You can help yourself at home by using these tips:

• Learn how to manage your pain, including using a pain diary.
• Take precautions to avoid falling, such as keeping floors clean and dry and removing clutter and throw rugs.
• Use weight-bearing exercises, such as walking, jogging, stair climbing, dancing, or lifting weights, to strengthen bones. Be sure that you do not place stress on bones affected by Paget's disease. Talk to your doctor or physical therapist about the best exercise program for your condition.
• Eat a nutritious diet and be sure you are getting adequate amounts of calcium and vitamin D. If you are at risk for developing kidney stones, you should talk with your doctor or nurse before adding these nutrients to your diet.
• Use a hearing aid if you have hearing loss, or use a "white noise" machine or background music if ringing in your ears is a problem.

Treatment if the condition gets worse

If Paget's disease gets worse, you may have complications such as osteoarthritis. In some cases, joint replacement surgery is needed. Sometimes doctors recommend surgery to relieve pressure on a nerve (such as a nerve pinched by the spine) or to correct deformed bones (such as bowed legs). Surgical choices include total joint replacement of a hip or knee and osteotomy, which may help you delay or avoid joint replacement surgery.