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Paget's Disease of Bone
Revised January 2008
Pain and Paget's Disease of Bone
Types of Pain
Paget's disease can cause several different kinds of pain, as described below.
Bone pain: Small breaks called microfractures can occur in pagetic bone. These breaks can cause pain, especially in weight-bearing bone such as the spine, pelvis, or leg.
Joint pain: Cartilage (a hard but slippery tissue that cushions the joints) can be damaged when Paget's disease reaches the end of a long bone or changes the shape of bones located near joints. This can result in osteoarthritis and joint pain.
Muscle pain: When bone is changed by Paget's disease, the muscles that support the bone may have to work harder and at different angles, causing muscle pain.
Nervous system pain: Bones enlarged by Paget's disease can put pressure on the brain, spinal cord, or nerves. This can cause headache; pain in the neck, back, and legs; and sciatica, a "shooting" pain that travels down the sciatic nerve from the lower back to the leg.
Available Treatments
It is important for most people with Paget's disease to receive medical treatment as soon as possible. Today's treatments can help reduce pain and possibly prevent the development of further complications.
Several types of medicines are used to address the pain caused by Paget's disease. A doctor may recommend drugs designed to control the Paget's disease or to relieve pain. The doctor also may recommend drugs to address painful complications of Paget's disease, such as arthritis.
When severe pain cannot be controlled with medicine, surgery on the affected bone or joint may be needed.
An appropriate program of regular exercise also can help people with Paget's disease reduce or eliminate pain.
Prescription Drugs Used to Treat Paget's Disease
Medicines used to treat Paget's disease help slow the rate at which affected bone is changed, thereby reducing pain. The Food and Drug Administration (FDA) has approved the prescription drugs in the following table for the treatment of Paget's disease.
| Prescription Drugs Used to Treat Paget's Disease | |||
|---|---|---|---|
| Drug | Brand Name1 | How Given | |
| Therapies of choice | Bisphosphonates | ||
| risedronate sodium | Actonel | Tablet | |
| alendronate sodium | Fosamax | Tablet | |
| pamidronate disodium | Aredia | Intravenous (through a vein) | |
| pamidronate disodium | generic only | Injection (with a needle) | |
| zoledronic acid2 | Reclast | Intravenous (through a vein) | |
| tiludronate disodium | Skelid | Tablet | |
| etidronate disodium | Didronel | Tablet | |
| Recommended for certain patients | |||
| Calcitonin | Miacalcin | Injection (with a needle) | |
1 Brand names included in this fact sheet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency.Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.
2 Zoledronic acid used for Paget's disease outside the U.S. is known as Aclasta; when used for certain cancer treatments, it is called Zometa.
Over-the-counter Drugs to Treat the Pain Caused by Paget's Disease
Several over-the-counter (nonprescription) drugs can be used to reduce the pain associated with Paget's disease. Each of these medicines is taken orally (by mouth), usually in tablet form. Although there are many brand names for these drugs, they can be purchased on the basis of their key ingredient, which is:
- Ibuprofen
- Naproxen
- Aspirin or
- acetaminophen.
In some cases physicians will recommend the use of pain-relieving medicine that requires a prescription.
Surgery to Manage Pain
Although surgery is rarely required for Paget's disease, it should be considered in certain circumstances. Hip or knee replacement surgery may help people with severe pain from Paget's disease-related arthritis. Surgery can also realign affected leg bones to reduce the stress and pain at knee and ankle joints or help broken bones heal in a better position.
The Value of Exercise
Physical exercise is an important tool for persons with Paget's disease. Regular exercise can help patients:
- maintain bone strength
- avoid weight gain (and the pressure added weight puts on weakened bone) and
- keep weight-bearing joints mobile and free of pain.
To make sure that pagetic bone is not harmed, patients should discuss their plans with a doctor before beginning any exercise program.
There Is No Need to Be in Pain
Although there is no cure for Paget's disease, people with the disorder do not have to live with constant pain. As this fact sheet describes, available therapies — especially when started early — can greatly reduce or, in some cases, eliminate the pain associated with the disease.
Resource
For more information about Paget's disease, contact:
-
The Paget Foundation
120 Wall Street, Suite 1602
New York, NY 10005
Phone: 212-509-5335
Toll Free: 800-23-PAGET
Fax: 212-509-8492
Email: pagetfdn@aol.com
Website: http://www.paget.org
For Your Information
This publication contains information about medications used to treat the health condition discussed here. When this fact sheet was printed, we included the most up-to-date (accurate) information available. Occasionally, new information on medication is released.
For updates and for any questions about any medications you are taking, please contact the U.S. Food and Drug Administration at:
-
U.S. Food and Drug Administration
Toll Free: 888-INFO-FDA (888-463-6332)
Website: http://www.fda.gov/
The National Resource Center acknowledges the assistance of The Paget Foundation in the preparation of this publication.
NIH Osteoporosis and Related Bone Diseases ~ National Resource Center
2 AMS Circle
Bethesda, MD 20892-3676
Phone: 202–223–0344
Toll Free: 800–624–BONE
TTY: 202-466-4315
Fax: 202-293-2356
Email: NIAMSBoneInfo@mail.nih.gov
Website: http://www.niams.nih.gov/Health_Info/bone/default.asp
The NIH Osteoporosis and Related Bone Diseases ~ National Resource Center provides patients, health professionals, and the public with an important link to resources and information on metabolic bone diseases. The mission of NIH ORBD~NRC is to expand awareness and enhance knowledge and understanding of the prevention, early detection, and treatment of these diseases as well as strategies for coping with them.
The NIH Osteoporosis and Related Bone Diseases ~ National Resource Center is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases with contributions from:
- National Institute on Aging
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- National Institute of Dental and Craniofacial Research
- National Institute of Diabetes and Digestive and Kidney Diseases
- NIH Office of Research on Women's Health
- DHHS Office on Women's Health.
The National Institutes of Health (NIH) is a component of the U.S. Department of Health and Human Services (DHHS).
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