METABOLIC BONE DISORDER
(PAGET’S DISEASE)
MR. YOGENDRA MEHTA
Lecturer
DEFINITION
Paget disease is a chronic bone disorder that
typically results in enlarged, deformed bones
due to excessive breakdown and formation of
bone tissue that can cause bones to weaken
and may result in bone pain, arthritis
deformities or fractures.
Paget's disease of bone is a condition that
affects the way your bone breaks down and
rebuilds (metabolizes).
Healthy bone metabolism allows for old bone
to be recycled into new bone throughout the
course of your life. In Paget's disease of bone,
the rate at which old bone is broken down and
new bone is formed becomes distorted. Over
time, the affected bones may become fragile
AETIOLOGY
The cause of Paget’s disease is unknown.
Up to 15% of affected individuals report a family history in a
first-degree relative, suggesting that genetic factors are important
in pathogenesis.
infectious
Genetics viral cause
Calcium &
Vit. D
Deficiency
RISK FACTORS
There are no known risk factors for Paget’s disease.
Older than
AGE 40 year
Men more
than
SEX Female
Close
FAMILY Paget’s disease
relative
HISTOR
Y
BONE INVOLVED IN PAGET’S DISEASE
Most common bones in Paget’s disease are:
The pelvis
Lumbar spine
Femur
Thoracic spine
Sacrum
Skull
Tibia and Humerus
Internal structure of bone, chest
Lower extremity
Hands and wrists
Feet
PATHOGENESIS
Age, Sex, Family History Infectious Virus, Genetics & Environment
Proliferation of Osteoclast
Lead to
Osteoclastosis activities than normal
As a result
Bone resorption
then held
Compensatory mechanism cause Osteoblastic activities
Lead to
Bone formation
As a bone turnover continues rapidity of new bone formation
develop
Classis mosaic pattern of bone( in size, structurally weaker, change in shape
cause
Pathological Fracture, Structural Bowing of the leg
Lead to
Malalignment of the hip, knee & ankle joint As a result Arthritis, Back & Joint
pain
CLINICAL FEATURES
Most common symptom is pain:-
o Bone pain
◦ Pain may be worse at night
◦ Headache
◦ Arm pain(bilateral)
◦ Leg pain(bilateral)
◦ Neck pain
o Joint Pain
◦ Shoulder pain(bilateral)
◦ Elbow pain
◦ Hip pain(bilateral)
◦ Knee pain(bilateral)
◦ Ankle pain
o Back pain
CLINICAL FEATURES Contd……………
Bowed legs
Bone tenderness
Loss of height
Fatigue
Headaches and hearing loss may occur when an overgrowth of
bone in the skull.
Tingling and numbness in an arm or leg If spine is affected, nerve
roots can become compressed.
Waddling Gait
Hip pain
Arthritis-Damage to cartilage of joints
DIAGNOSIS
History
Physical Examination
Physical findings in someone with Paget's disease may
include:
Bowing of long bones
Decreased motion
Difficulty in walking
Enlarged skull
Kyphosis of the spine
Loss of hearing
Muscle weakness
DIAGNOSIS Contd………
Radiology
Bone X-Ray- show areas of bone reabsorption, enlargement of the
bone and deformities, bowing of your long bones.
Bone Mass Density
Laboratory test
Blood- Alkaline phosphatase- Elevated
Urine- Hydroxyproline- Increased
Bone Biopsy
MANAGEMENT
General measures
give information and education about it.
Treat the patient with the multidisciplinary team i.e surgeon,
physiotherapist and occupational therapist.
Patients with lower limb deformities may develop secondary foot
problems and should be referred for podiatric assessment.
Advice about suitable shoe-wear or the provision of simple foot
orthosis which can often result in reduced pain and improved
mobility.
MANAGEMENT Contd…………
General measures
Encourage patient with lower limb for the degree of activity and
rest that they can undertake, including the importance of pacing
and planning activities.
They should receive counseling about lifestyle measures to reduce
risk of falls.
patients should have audiometry and provision of a hearing
aid if necessary.
Cane or Walker
PHARMACOLOGICAL MANAGEMENT
The goal of drug treatment is to control Paget's disease
activity for as long a period of time as possible.
If you don't have symptoms, you may not need treatment.
NSAIDs for pain- Naproxen, Ibubrufen, Ketoprofen
Calcium supplement: (1000-1500 mg/day)
Vitamin D supplement: (400 units/day)
Biphosphonates- to stabilize rapid bone turnover
SURGICAL PROCEDURE
The purposes of surgery to
Help fractures heal
Replace joints damaged by severe arthritis
Realign deformed bones
Reduce pressure on nerves
Surgical procedure
Total Hip replacement
Spine surgery to correct spinal cord compression
COMPLICATIONS
Fractures:
Osteoarthritis:
Heart failure:
Bone cancer:
Loss of Vision
Paraplegia
Spinal stenosis
Deafness
WARNING SIGN OF PAGET’S DISEASE
Notify the doctor if you have Paget's disease and any of the
following:
Difficulty in walking
Inability to take prescribed medications
Kyphosis
Abnormal curvature to the upper spine
Loss of height
Joint pain and Joint swelling
Worsening back pain, hip pain and joint pain
NURSING CONSIDERATION
Nursing Assessment
Asses the pain and function ability of the affected part.
Observe for bowing leg or waddling gait.
Assess for cardiovascular complications.
Assess for auditory symptoms- tinnitus, vertigo & hearing loss.
• Nursing Diagnosis
Pain R/T pathophysiologic process.
Risk for injury R/T fall , fragile and dense bone structure bow,
weak leg.
NURSING CONSIDERATION Contd………….
Nursing Action
Reducing pain
-administer and teach self administration of analgesics.
-position the patient as ordered or frequently if there is no restriction.
Dietary Therapy
-Encourage patient to take more calcium diet.
- Ask patient to have regular Vitamin D.
NURSING CONSIDERATION Contd………….
Preventing injury
Establish exercise protocols through a physiotherapist to maintain
physical abilities and prevent from fall.
Assist the patient with activities as necessary.
Provide heel lift, walking aids as needed.
• Surgery Intervention
Do perioperative care to the patient as needed.
• Encourage Client to Stay active – exercise helps to maintain
bone health and joint mobility, as well as strengthen muscles.
• Aggressive physical activity is not recommended, as the risk
of fracture is high.
HOME BASED CARE
Ask Family to remove slippery floor coverings, use nonskid
mats in your bathtub or shower, tuck away cords, and install
handrails on stairways and grab bars in your bathroom, use a
cane or a walker to prevent from fall.
Maintain good lighting to prevent from fall injury.
Provide education about the disease process and medication.
Educate the patient about the use of mobility aids.
Ask patient to give rest to the painful joint with use of
walker, crutches and cane.
HOME BASED CARE Contd……..
Follow an exercise plan developed with your doctor.
Perform gentle stretching after exercise.
Encourage patient to loose weight if she/he is overweight.
Apply warm compresses for stiffness for 20-30 minutes,
every 1-2 hours.
Use splints when the joints are swollen.
PREVENTION
Avoid Avoid
Smoking Smoke
PAGET’S
DISEASE
Avoid Avoid
Alcohol prolong
standing
Calcium &
Vitamin D
Diet
THANK
THANK
YOU YOU
