Treatments and drugs

By Mayo Clinic Staff

If you don't have symptoms, you may not need treatment. However, if the disease is active — indicated by an elevated alkaline phosphatase level — and is affecting high-risk sites in your body, such as your skull or spine, your doctor may recommend treatment to prevent complications, whether or not you have symptoms.

Medications

Osteoporosis drugs (bisphosphonates) are the most common treatment for Paget's disease of bone. Some bisphosphonates are given as oral medications, while others are given by injection. Oral bisphosphonates are generally well tolerated, but may irritate your gastrointestinal tract. Examples include:

  • Alendronate (Fosamax)
  • Ibandronate (Boniva)
  • Pamidronate (Aredia)
  • Risedronate (Actonel)
  • Zoledronic acid (Zometa, Reclast)

Long-term bisphosphonate therapy has been linked to a rare problem in which the upper thighbone cracks, but doesn't usually break completely. Bisphosphonates also may increase the risk of osteonecrosis of the jawbone — a rare condition in which a section of jawbone dies and deteriorates after a tooth extraction.

If you can't tolerate bisphosphonates, your doctor may prescribe calcitonin (Miacalcin), a naturally occurring hormone involved in calcium regulation and bone metabolism. Calcitonin is a drug that you administer to yourself by injection or nasal spray. Side effects may include nausea, facial flushing and irritation at the injection site.

Surgery

In rare cases, you may require surgery to:

  • Help fractures heal
  • Replace joints damaged by severe arthritis
  • Realign deformed bones
  • Reduce pressure on nerves

Paget's disease often causes the body to produce an excessive number of blood vessels in the affected bones. This change increases the risk of serious blood loss during an operation. If you're scheduled for surgery that involves bones affected by Paget's disease, your doctor may prescribe medications to reduce the activity of the disease, a step that tends to reduce blood loss during surgery.

Feb. 13, 2013