Treatment - Paget's disease of bone

There's currently no cure for Paget's disease of bone, but treatment can help relieve the symptoms.

If you do not have any symptoms, your doctor may suggest keeping an eye on your condition and delaying treatment until any problems occur.

Bisphosphonates

Bisphosphonates are medicines that help regulate bone growth. They work by affecting the cells that absorb old bone (osteoclasts).

If you need bisphosphonates you'll usually have a medicine called zoledronate. It's given as a single dose through a drip in your arm (infusion).

Zoledronate can help reduce pain for several years at a time. Treatment can be repeated when the effect starts to wear off.

Other bisphosphonates that are sometimes used include risedronate, taken as tablets, and pamidronate, given as injections.

The main side effects of zoledronate and pamidronate are flu-like symptoms that last a day or 2. The most common side effect of risedronate is an upset stomach.

Zoledronate can decrease your levels of calcium, so you'll usually be advised to take calcium and vitamin D supplements for several days after having the infusion.

If you're unable to have bisphosphonates, you may need daily injections of another medicine that prevents bone loss called calcitonin, usually for up to 3 months.

Supportive therapies

Some people with Paget's disease benefit from supportive therapies such as physiotherapy or occupational therapy.

These therapies involve exercises and techniques that can help reduce pain, improve movement and make everyday tasks easier.

Devices that reduce the weight placed on the affected bones may also help, such as:

• a walking stick or frame
• orthotics – insoles made of plastic that fit inside your shoe to help support your feet
• braces that support the spine in the correct position

Surgery

Surgery is usually only needed if further problems develop, such as fractures, deformities or severe osteoarthritis.

Operations that may be done include procedures to:

• realign the bones after a fracture so that they heal correctly
• remove and replace a damaged joint with an artificial one, such as a hip replacement or knee replacement
• cut and straighten deformed bones
• move bone away from a squashed (compressed) nerve

These operations are usually done under general anaesthetic, so you'll be asleep and will not experience any pain while they're carried out.

Diet and nutrition

Calcium and vitamin D help keep your bones healthy. If you have Paget's disease of bone, it's important to ensure you get enough of these.

You get calcium from your diet. It's found in foods such as:

• dairy foods – such as milk and cheese
• green leafy vegetables – such as broccoli and cabbage
• soya beans, soya drinks with added calcium and tofu

You get most of your vitamin D from sunlight, although it's also found in some foods such as oily fish.

Sometimes your GP may suggest taking extra calcium and/or vitamin D supplements to ensure you're getting enough.