Paget's disease of bone

Known as osteitis deformans A chronic disorder that typically results in

enlarged and deformed bones Paget's disease can cause bone to

weaken, Bone pain The excessive breakdown and formation

of bone tissue arthrites deformities,

cause

Virus infections

Canine distemper virus

Respiratory syncytial virus

Paramyxovirus

Symptoms Bone pain is the most common symptom

Headaches and hearing loss may occur when Paget's disease affects the skull

Pressure on nerves may occur when Paget's

disease affects the skull or spine.

Drowsiness

Symptoms Increased head size Curvature of spine may occur in advanced

cases Hip pain may occur when Paget's disease

affects the pelvic or thigh bone Damage to joint cartilage may lead to arthrities Teeth may spread intraorally Chalkstik #: Chalkstick fractures are fractures,

typically of long bones, in which the fracture is transverse to the long axis of the bone, like a broken stick of chalk.

Diagnosis

Diagnosis

Skull radiograph

cotton wool" appearance of the cranial vault

Radiograph of left femur

Bone with cortical thickening

TreatmentDrug Therapy

Surgery

Diet & Exercise

Drug TherapyBisphosphonatesFive bisphosphonates are currently

available. Didronel (etidronate disodium) -- Tablet; approved

regimen is 200–400 mg once daily for 6 months;

Aredia (pamidronate disodium) -- Intravenous; approved regimen 30 mg infusion over 4 hours on 3 consecutive days;

Fosamax (alendronate sodium) -- Tablet; 40 mg once daily for 6 month

Bisphosphonates

Skelid (tiludronate disodium) -- Tablet; 400 mg (two 200 mg tablets) once daily for 3;

Actonel (risedronate sodium) -- Tablet; 30 mg once daily for 2 months;

Calcitonin

Miacalcin is administered by injection; 50 to 100 units daily or 3 times per week for 6-18 months

Surgery

•There are generally two major complications of Paget's disease for which surgery may be recommended.

Surgery

Severe degenerative arthritis -- If disability is severe and medication and physical therapy are no longer helpful, joint replacement of the hips and knees may be consider

Bone deformity -- Cutting and realignment of Pagetic bone (osteotomy) may help painful weight bearing joints, especially the knees.

Diet and Exercise

Patients with Paget's disease should receive 1000-1500 mg of calcium

Adequate sunshine

At least 400 units of vitamin D daily

This is especially important in patients being treated with bisphosphonates.

Exercise

Avoiding weight gain Maintaining joint mobility Flexibility exercises, such as

stretching, improve the range of motion of muscles and joints

Undue stress on affected bones should be avoided

Relieve of pain

SHOULDER EXERCISE The shoulder shrug is another technique

that may improve posture and reduce back pain

Begin by standing erect with dumbbells or water bottles held at the sides of the body

Lift the shoulders toward the head by elevating the shoulder girdle, and slightly retract the scapulae to rotate the shoulders back

SHOULDER EXERCISE

Pause, and then return to the starting position.

Avoid rocking or using the legs to initiate the exercise by slightly bending your knee

Repeat the exercise three to five times

KNEE EXCERCISE

A good starting point is the squat which targets the gluteals, hamstrings, and quadriceps

Start by standing erect with a neutral spine and feet shoulder-width apart

Slowly lower the body, with the hips moving back as if sitting in a chair.

KNEE EXCERCISE

Maintain the weight directly over the heels or mid-foot

Lower to approximately 90 degrees of knee flexion.

Pause, and then slowly return to the starting position

Remember to keep the weight over the back portion of the foot rather than the toes; raise the arms to shoulder height to counterbalance.

KNEE EXCERCISE

Repeat the exercise three to five times

If you have trouble lowering your body until 90 degrees of knee flexion consider placing a chair behind you with some pillows in the chair.

  This way, you can lower your body until about

70 degrees of knee flexion (or until you feel the pillows on the chair), pause at that amount of knee flexion, and then return to starting position

KNEE EXCERCISE

The heel raise is another good exercise that targets the gastrocnemius and soleus

Plantarflex up (stand on the toes) pause, then slowly lower to the starting position.

Lastly the knee to chest technique is a great maneuver to help stretch the lower extremity and prevent cramping

KNEE EXCERCISE

Lie on your back and pull one knee to your chest.

Perform 1-2 sets of 3-5 repetitions per side

Each repetition should last 15-30 seconds