If you don’t have symptoms, you might 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 might recommend treatment to prevent complications, even if you don’t have symptoms.
Osteoporosis drugs (bisphosphonates) are the most common treatment for Paget’s disease of bone. Some bisphosphonates are taken by mouth, while others are given by injection. Oral bisphosphonates are generally well-tolerated, but may irritate your gastrointestinal tract. Examples include:
- Alendronate (Fosamax)
- Ibandronate (Boniva)
- Risedronate (Actonel)
Zoledronic acid (Reclast) and pamidronate (Aredia) are intravenous bisphosphonate drugs. Zoledronic acid which is now an inexpensive generic drug is the most effective therapy for Paget’s disease. A single 15 minute infusion suppresses disease activity to normal for up to 6.5 years in the great majority of patients. The drug is not indicated in the presence of a significant decrease in kidney function.
Rarely, bisphosphonate therapy has been linked to severe muscle, joint or bone pain, which almost always resolve when the medication is discontinued. Intravenous therapy may produce several days of fever and muscle aches in 30-40% of patients. This is less likely to happen if vitamin D levels are normal prior to the infusion. Bisphosphonates also can increase the risk of a rare condition in which a section of jawbone dies and deteriorates (osteonecrosis of the jawbone), usually associated with dental disease or a tooth extraction.
If you can’t tolerate bisphosphonates, your doctor might 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. It is generally less effective than bisphosphonates.
In rare cases, surgery might be required to:
- Help fractures heal
- Replace joints damaged by severe arthritis
- Realign deformed bones
- Reduce pressure on nerves
Paget’s disease of bone often causes the body to produce too many blood vessels in the affected bones, increasing 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 might prescribe medications to reduce the activity of the disease, which tends to reduce blood loss during surgery.