Dear Doctors: I was recently diagnosed with Paget’s disease after suffering fatigue symptoms and muscle soreness in my neck, pelvic and lower-leg areas. I am sore and lethargic upon waking up in the morning. What can you tell me about Paget’s, treatments and research advances?
Dear Reader: The full name of the condition you have been diagnosed with is Paget’s disease of bone. Also known as osteitis deformans, it is a chronic bone disorder. When someone has Paget’s disease, it means the process of bone remodeling, which is the cycle of bone growth, has become abnormal. The result is that over time, bones can become larger, weaker and misshapen.
To understand the condition, we should begin with bone remodeling. This is the lifelong process by which our bodies replace old or damaged bone with new bone. It not only keeps the skeletal structure strong and resilient, but it also helps maintain the optimal balance of calcium and phosphorus in the body. Specialized cells known as osteoclasts degrade the bone and facilitate the absorption of the resulting minerals, primarily calcium, into the bloodstream. Another type of specialized cells, called osteoblasts, produce a protein-rich compound known as osteoid. This, along with various growth factors, is deposited on the bone. It fills in the gaps with new bone, which renews and strengthens the skeletal structure.
In Paget’s disease, the balance between bone removal and bone building gets disrupted. Bone building begins to occur at a faster pace than bone removal. The resulting new bone is brittle, weak and sometimes causes bones to become abnormal in shape. The disorder usually affects just one or several bones, not the entire skeleton. The most common areas are the skull, legs, spine and pelvis.
Symptoms of Paget’s disease include the fatigue and discomfort you have experienced. Sometimes, changes to bone shape are visible. People living with Paget’s are more susceptible to bone fractures, kidney stones and osteoarthritis. Depending on the area affected, hearing loss and pinched spinal nerves are possible.
The causes of Paget’s disease are not yet understood. The disorder can run in families, and researchers have recently identified possible links to certain genes. Environmental factors and even viral infection are being explored as possible contributors.
The disease is more common in men than women and occurs most often after age 50. Unfortunately, there is no cure at this time. Instead, the abnormal cycle of bone growth is managed with medications. These include bisphosphonates and calcitonin, which slow bone remodeling. Pain medications may be used to ease discomfort, and surgery can become necessary to correct bone deformity.
Lifestyle changes can help, as well. Calcium and vitamin D improve bone strength, but due to the increased risk of kidney stones, it’s a good idea to get medical guidance regarding diet. Moderate exercise helps maintain a healthful weight, which eases stress on fragile bones. Weight-bearing and strengthening exercises are also important.
People living with Paget’s are at increased risk of fractures, so identify and remove any tripping hazards in the home. The disorder can affect other parts of the body, so be aware of new symptoms, and be sure to seek help when needed.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.