Paget disease of bone

Paget disease of bone is a localized disorder of bone turnover in which breakdown and formation become excessive and disorganized. Affected bone may enlarge while becoming less mechanically reliable. Vertebral involvement can cause pain, deformity, fracture or pressure on nervous structures.

Lire cette fiche en français

Disorganized bone remodelling

Paget disease may affect one bone or several, commonly including the pelvis, spine, skull and long bones. It is different from generalized osteoporosis and from Paget disease of the breast. Many people are diagnosed through imaging or blood testing performed for another reason.

Manifestations and warning signs

Bone pain, deformity, secondary arthritis or fracture may occur. An enlarged vertebra can reduce space for nerves. Rapidly progressive weakness, urinary retention or saddle numbness requires immediate emergency assessment. New unusual pain or a growing mass needs medical evaluation to investigate a potential complication.

Diagnosis

Radiographs show characteristic changes. Alkaline phosphatase helps assess activity but can remain normal when involvement is limited. A bone scan may map affected areas. Interpretation distinguishes metastases, fractures and other remodelling abnormalities. Pain in someone with Paget disease is not automatically caused by active pagetic bone.

Treatment and follow-up

Bisphosphonates, often zoledronic acid when appropriate, may be offered for symptomatic active disease. Decisions account for kidney function and mineral status, among other factors. Fracture, severe arthritis or neurological compression may require separate treatment, sometimes surgery. Follow-up combines symptoms with selected investigations rather than relying on a laboratory result alone.

Role of TAGMED care

Diagnosis and treatment of abnormal bone turnover require medical management. TAGMED may consider functional support after bone strength and fracture risk have been assessed. Manual forces and exercises must be adapted; traction cannot normalize the underlying bone-remodelling process or replace prescribed medical treatment.

Frequently asked questions

Is Paget disease a cancer?

No. Tumour transformation is rare, but a new pain pattern needs assessment.

Is it always painful?

No. Some forms remain asymptomatic.

Is a larger bone necessarily stronger?

No. Its internal structure may be less mechanically reliable.

Must every abnormal blood test be treated?

Decisions depend on symptoms, activity and the overall clinical situation.

Can physical activity continue?

Yes, with adjustments for the affected bones and fracture risk.

Educational information from The Spine Page. This entry does not replace an individual assessment. Documentary version: October 12, 2026. Sylvain Desforges, B.Sc., D.O., N.D., osteopath and naturopath.