Paget’s disease is often treated with a group of drugs called bisphosphonates. These drugs are often used in the treatment of osteoporosis but at a different dose and for a different length of time. They work by damping down the overactive renewal and repair process, which in Paget’s disease is much faster than normal. These drugs act mainly on the osteoclasts (the cells that break down old bone) to slow down the rapid bone turnover. Drugs in this group include:
Series of weekly or fortnightly injections (6 in total) or as a single infusion
Tablets given daily for 2 months
||Tablets given daily for 3 months
|Tablets given daily for 3–6 months
If you're taking bisphosphonate tablets, you should take them around the same time each day. You shouldn’t take them within two hours either side of taking a calcium supplement because calcium can reduce the amount of the drug your body absorbs.
Bisphosphonates are often effective at easing bone pain caused by Paget’s disease, but it may take 3–6 months for your symptoms to improve. You may need further courses if your symptoms come back, but their effect often lasts for at least a year and sometimes for much longer.
These treatments are well tolerated and unlikely to cause serious side-effects. The most common side-effects are:
- flu-like symptoms lasting 1–2 days – with pamidronate and zoledronate
- a mild stomach upset – with risedronate, tiludronate and etidronate.
If you can’t tolerate bisphosphonates, you may be treated with a drug called calcitonin, which can be given as a daily injection.
You’ll probably also need painkillers such as paracetamol and/or non-steroidal anti-inflammatory drugs (NSAIDs), which are especially effective at reducing pain caused by osteoarthritis and nerve compression.
A therapy assessment, generally by a physiotherapist, can be very helpful. They can, for example, identify whether one of your legs has become shorter because your thigh and shin bones have become curved. In this case, a built-up insole in your shoes can reduce any feelings of lopsidedness.
Physiotherapists can also give you muscle-strengthening exercises that may be useful, while an occupational therapist can offer you advice on walking aids and other aspects of daily living.
Read more about physiotherapy and occupational therapy.
You probably won’t need surgery, but sometimes if a bone breaks you’ll need an operation to fix it, depending on the type of break and how bad it is. If you later develop osteoarthritis as a result of having Paget's disease, then joint replacement surgery may sometimes be necessary.
Back surgery is occasionally needed if a bone in your back is enlarged and causing pressure on the nerves in the spine.