What is Paget's disease?
Paget's disease is a long-lasting (chronic) condition that causes abnormal bone growth. Bone is constantly being replaced as bone tissue is broken down and absorbed into the body, then rebuilt with new cells. In the early stages of Paget's disease, bone tissue is broken down and absorbed much faster than normal. To keep up with the rapid breakdown of bone tissue, the body speeds up the bone rebuilding process. But this new bone is often weak and brittle, causing it to break (fracture) more easily.
Paget's disease usually affects the bones in the pelvis , spine , thigh (femur ), skull, shin (tibia), and upper arm (humerus ). One bone or several bones may be affected by Paget's disease.
What causes Paget's disease?
The cause of Paget's disease is not clear. Genetic factors and viruses may play a role in the development of the disease.
What are the symptoms?
Most people with Paget's disease have no symptoms. When symptoms are present, the most common are bone pain, deformed bones (bowed legs, enlarged skull or hips, or a curved backbone), and fractures. Because the bone pain may be aching and hard to describe, you may think it is part of the aging process.
Other symptoms may occur as the result of the location of Paget's disease. For example, the disease can affect the skull and cause headaches, dizziness, loss of muscle strength in the face (facial droop), or problems with vision or hearing. When the disease affects the spine, nerves can become damaged and cause leg pain, numbness, weakness, or cauda equina syndrome (an emergency condition with symptoms that includPublishe loss of feeling in the pelvic area and legs).
How is Paget’s disease diagnosed?
Most often, Paget's disease is discovered when you see a doctor or nurse for a different reason, such as hip or back pain. A bone X-ray or a blood test with above-normal levels of the enzyme alkaline phosphatase often leads to the discovery of the disease. Doctors usually diagnose Paget's disease based on your medical history, a physical exam, bone X-rays, lab tests, and possibly a bone scan.
How is it treated?
Paget's disease is treated with medicines that slow the rapid breakdown of bone tissue. You might also take medicines to relieve pain. You may need treatment to try to prevent complications such as osteoarthritis even if you do not yet have symptoms of Paget's disease. Later in the disease process, you may need surgery to replace a hip or knee joint damaged by the disease.
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Medications for Ostheoporosis
- Estrogen: For newly menopausal women, estrogen replacement is one way to prevent bone loss. Estrogen can slow or stop bone loss. And if estrogen treatment begins at menopause, it can reduce the risk of hip fracture up to 50%. It may be taken orally or as a transdermal (skin) patch (for example, Vivelle, Climara, Estraderm, Esclim, Alora).
- Many women past menopause also choose estrogen replacement therapy because of its proven usefulness in slowing the progression of, or preventing, osteoporosis.
- Recent studies question the safety of long-term estrogen use. Women who take estrogen have an increased risk for developing certain cancers. Although it was once thought that estrogens confer a protective effect on the heart and blood vessels, recent studies have shown that estrogens cause an increase in coronary heart disease, stroke, and venous thromboembolism (blood clots). Many women who take estrogens have side effects (such as breast tenderness, weight gain, and vaginal bleeding). Estrogen's side effects can be reduced with proper dosing and combination. If you have had a hysterectomy, estrogen alone is needed. For women with an intact uterus, progestin is always part of hormone replacement therapy. Ask your doctor whether estrogen is right for you.
- A daily intake of 1,200-1,500 mg (through diet and supplements) is recommended. Take calcium supplements in doses of less than 600 mg. Your body can only absorb so much at one time. The best way may be to take one supplement with breakfast and another with dinner.
- Alendronate (Fosamax): This medication is used to treat osteoporosis and to prevent bone loss in women. In clinical trials, alendronate has been shown to reduce the risk of new spinal and hip fractures by 50%. Gastrointestinal problems, such as nausea, acid reflux symptoms, and constipation, are the most common side effects. You must take this medication first thing in the morning with a large glass of water and not lie down or eat for 30 minutes. Some women find this restriction difficult. This medication is taken daily or once a week.
- Calcitonin (Miacalcin): Calcitonin is a hormone (extracted from salmon) that slows bone loss and may increase bone density. You may be given this drug as an injection (every other day or two to three times a week) or as a nasal spray.
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Osteoporosis Drugs May Suppress Bones' Ability to Heal
The long-term use of osteoporosis drugs known as bisphosphonates can actually weaken bones by impairing their ability to heal, leading to fractures, according to a study conducted by researchers from New York-Presbyterian Hospital/Weill Cornell Medical Center.
Researchers reviewed the files of all 70 people who had been admitted to the hospital's Level 1 trauma center between 2002 and 2007 for fractures of the thigh bone (femur). Fifty-nine of the patients were women, and 25 were taking the bisphosphonate drug Fosamax, known generically as bisphosphonate alendronate.Of the 20 people who had suffered a stress fracture due to very little or even no trauma, 19 were taking Fosamax. The other individual had cancer.The researchers also found that Fosamax patients with this type of fracture had been taking the drug longer by an average of 6.9 years, compared with an average of 2.5 years in those with other kinds of fractures. The correlation between Fosamax and stress fractures was found to be independent of age, race, weight or osteoporosis history."While bisphosphonates like Fosamax have been proven to successfully treat osteoporosis and other metabolic bone disease, we believe long-term use of these drugs may suppress the ability of bones to heal in some patients," said researcher Dean G. Lorich. "As a consequence, patients with routine stress fractures are unable to properly heal, and minor damage can worsen until a serious fracture occurs."Bisphosphonates interfere with the activity of osteoclasts, which break down bones in order to transfer calcium into the blood."While more research is necessary to confirm our results, physicians prescribing bisphosphonates for longer durations should monitor patients for indications of bone regeneration," researcher Joseph M. Lane said.
While the correlation with fractures has so far only emerged in Fosamax, researchers noted that other bisphosphonate drugs are less widely prescribed and have not been on the market as long, so the effects may not have had time to show up.
Diet is a Key to Preventing and Treating Osteoporosis
Osteoporosis is a condition in which bones become weak and thin, and prone to fracture, particularly in the hips and spine. There can be few symptoms of osteoporosis until a fracture occurs, so it can only be diagnosed by a bone scan.
Approximately one in four post-menopausal women develops osteoporosis. Certain other factors are thought to be risk factors for developing osteoporosis including family history, heavy alcohol use, hyperthyroidism and hyper parathyroidism, smoking, long term use of anticonvulsants and glucocorticosteroids and being white or Asian race. Dietary-wise, those people who eat an imbalanced diet resulting in too many acidifying foods are more likely to develop
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Risk Factors for Osteoporosis
Several key risk factors for developing osteoporosis include:
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Advanced age. Those over 65 years of age are at particular risk.
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Gender. Women are at much greater risk, losing bone more rapidly than men due to menopause. However, men are also at risk and constitute 20% of the patient population with osteoporosis.
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Family and personal history. This includes family history of osteoporosis, history of fracture on the mother’s side of the family, and a personal history of any kind of bone fracture as an adult (after age 45).
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Body type. At greater risk are small-boned women who weigh less than 127 pounds.
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Menstrual history and menopause. Normal menopause alone increases a woman’s risk of osteoporosis. Early menopause or cessation of menstruation before menopause increases the risk even more.
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(Males) Hypogonadism (small gonads, e.g., testosterone deficiency)
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Lifestyle. Lifestyle behaviors that increase osteoporosis risk include: calcium and/or vitamin D deficiency; little or no exercise, especially weight-bearing exercise; alcohol abuse; cigarette smoking.
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Chronic diseases and medications. Certain types of medications can damage bone and lead to what is termed “secondary osteoporosis”. This type of osteoporosis occurs in 20% of women and 40% of men with osteoporosis. Included in this category are certain medications to treat endocrine disorders such as hyperthyroidism, marrow disorders, collagen disorders, gastrointestinal problems and seizure disorders. Long-term use of glucocorticoids (oral steroids) to treat diseases such as asthma or arthritis can be particularly damaging to bone. Given the serious nature of the diseases these medications treat, it is not advisable to alter or stop taking these drugs unless under a physician’s advice.
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Medications that prevent bone loss and breakdown
Currently, the most effective medications for osteoporosis that are approved by the FDA are antiresorptive agents, which decrease the removal of calcium from bones. The bone is a living dynamic structure; it is constantly being built and removed (resorbed). This process is an essential part of maintaining the normal calcium level in the blood and serves to repair tiny cracks in the bones that occur with normal daily activity and to remodel bone based on the physical stresses placed on the bone.
Osteoporosis results when the rate of bone resorption exceeds the rate of bone rebuilding. Antiresorptive medications inhibit removal of bone (resorption), thus tipping the balance in favor of bone rebuilding and increasing bone density. HRT is one example of an antiresorptive agent. Others include alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), ibandronate (Boniva), calcitonin (Calcimar), zoledronate (Reclast), and denosumab (Prolia).
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Could you have Signs of Osteoporosis?
This checklist can help you decide if you are at risk for osteoporosis and if you should talk to your doctor or pharmacist about what you can do.
Examine your heritage:
• Are you Caucasian or Asian? These two ethnic groups are more likely to develop osteoporosis than are other ethnic groups.
• Are you thin and petite? Because small people, women in particular, have less bone mass to begin with, they are at greater risk for the disease.
• Do you have older relatives who have curvature of the spine (sometimes called “dowager’s hump”), loss of height, fractures, or chronic back pain? If so, you may have inherited a tendency toward osteoporosis.
Examine your personal health history:
• Have you passed menopause? In women, estrogen aids in the production of bone mass. At menopause, the amount of estrogen their bodies produce declines sharply.
• Have your menstrual periods stopped? Women who have had a hysterectomy, women who are high-performance athletes, and women who diet excessively or who have an eating disorder may stop having periods. These women have had a hormonal change that can cause bone loss.
• Are you taking medicines that increase the risk of osteoporosis? The most common culprits are steroid medications (for example, cortisone, prednisone, and dexamethasone) and high doses of thyroid hormone. Long-term use of these medicines can cause bone loss.
Examine your lifestyle:
• Do you smoke? Smoking is linked strongly to bone loss. In some people, smoking causes as much as 5% to 10% of their total bone loss.
• Is your diet low in calcium and vitamin D? Calcium helps build and maintain healthy bone mass, and your body needs vitamin D to be able to use the calcium in your diet.
• Are you a moderate or heavy drinker? Alcohol intake can reduce the amounts of calcium and vitamin D in your body.
• Are you immobile or inactive? People who are confined to bed or who must wear a cast for a long time lose bone mass from lack of use. The same is true for people who do not get enough exercise in their daily lives.
• Talk to your doctor or pharmacist about your risk for osteoporosis. One way to determine your risk for fracture is a bone-density test to see if you have hidden bone loss. This test is painless, takes little time, and is much like an x-ray or ultrasound. Without this test, a fracture may be your first sign that you have osteoporosis.
Osteoporosis.
What is osteoporosis?
Osteoporosis, or porous bone, is a disease in which there is a loss of bone mass and destruction of bone tissue. This process causes weakening of the bones and makes them more likely to break. The bones most often affected are the hips, spine, and wrists.
Who is affected by osteoporosis?
Osteoporosis affects over 10 million Americans, with women four times more likely to develop osteoporosis than men. Another 34 million have low bone mass and therefore have an increased risk for osteoporosis. Estrogen deficiency is one of the main causes of bone loss in women during and after menopause. Women may lose up to 20 percent of their bone mass in the five to seven years following menopause.
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Possibles Causes of Osteoporosis
Osteoporosis is a disease caused principally by the significant loss of bone mineral density (BMD). Early in life, more bone is laid down than is removed, and an individual’s peak bone mass is typically achieved by around age 30. After peak bone mass is reached, the remodeling process (the process of laying down new bone and removing old bone) takes away more bone than is replaced. Hence making the bones more prone to osteoporosis (and consequently to fracture).
Thus, the process of bone loss typically begins between one’s early to late thirties. Starting from about that age to the onset of menopause, women lose a certain amount of bone steadily every year, as follows:
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Trabecular bone (the spongy bone inside the hard, cortical bone) is lost at a rate of about 1% per year
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Cortical bone (the hard bone) is lost at a rate of about 0.5% per year
Estrogen plays an important part in maintaining bone strength because it helps keep bone 
remodeling (which is now taking away more bone than is added) rates low. There are two lines of cells for bone remodeling, the bone-eating cells (osteoclasts) and the bone-forming cells (osteoblasts). Without estrogen, the osteoclasts are favored and more bone is resorped (removed) than laid down, resulting in thinning of the bone.
Therefore, when women reach menopause and their estrogen levels decrease, the rate of bone loss increases to about 2% to 3% per year. After 8 to 10 years, the rate of bone loss returns to the previous rate of 1% and 0.5% per year, respectively. This loss of bone density, particularly after women reach menopause, is one of the primary causes of osteoporosis in women.
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Treatment Alternatives.
- Weight-bearing exercise
Exercise is an important treatment for osteoporosis to maintain healthy bones. Activities that stress bones have been shown to have a positive effect in maintaining and increasing bone mass and preventing osteoporosis. Individuals who live a sedentary lifestyle have weaker bones and are subjected to a higher risk of sustaining pathologic fractures. While resistance forms of exercise (e.g. light weights) are excellent to stimulate bone production, even light aerobic exercise (e.g. aerobics, jogging, walking) can help strengthen bones and prevent osteoporosis. - Nutrition supplementation
Calcium supplementation is an important treatment to ensure oral intake is at least 1200 to 1500 mg every day. Comsuming this quantity of calcium is a difficult task considering that to do this you would have to eat or drink the equivalent of five glasses of milk each day. Because of this, many patients at-risk for osteoporosis should take an oral calcium supplement each day. This can be taken with Vitamin D (400-800 Units is recommended) to help increase the absorption. Also, caffeinated substances (e.g. coffee, soda, etc.) decrease calcium absorption, and should be avoided! - Medications
There are several available medications used for osteoporosis treatment. These include: - Bisphosphanates (Fosamax)
Bisphosphanates (e.g. Fosamax, Actonel) are a type of medication that helps to regulate calcium and prevent bone breakdown. Bone turnover, or replacement of old bone with new bone, is a normal process within our body. In patients with osteoporosis, the replacement with new bone does not maintain pace with the breakdown of old bone. Bisphosphanates slow the rate of bone breakdown to help maintain bone mass by inhibiting the osteoclast, the cell responsible for bone breakdown.
