Paget's Disease of Bone

This chapter discusses the etiology, pathology, clinical features, diagnosis, and treatment of Paget's disease. Although Paget's disease is the second most common bone disease after osteoporosis, the factors involved in its pathogenesis are just beginning to be clarified. Both genetic and environmental factors have been implicated in the pathophysiology of Paget's disease. The initiating lesion in Paget's disease is an increase in bone resorption due to an abnormality in the osteoclasts found at affected sites. Measurements of biochemical markers of bone turnover are useful clinically in the assessment of the extent and severity of disease in the untreated state and for monitoring the response to treatment. Specific antipagetic therapy consists of those agents capable of suppressing the activity of pagetic osteoclasts. Other symptomatic treatments for Paget's disease, including analgesics, anti-inflammatory drugs, use of orthotics or canes, and selected orthopedic and neurosurgical interventions, have important roles in management in many patients.