Differential diagnosis
Treatment
Although initially diagnosed by a primary care physician, endocrinologists (internal medicine physicians who specialize in hormonal and metabolic disorders), rheumatologists (internal medicine physicians who specialize in joint and muscle disorders), orthopedic surgeons, neurosurgeons, neurologists, oral and maxillofacial surgeons, and otolaryngologists are generally knowledgeable about treating Pagets disease and may be called upon to evaluate specialized symptoms. It can sometimes be difficult to predict whether a person with Pagets disease, who otherwise has no signs or symptoms of the disorder, will develop symptoms or complications (such as a bone fracture) in the future. Medication
The goal of treatment is to relieve bone pain and prevent the progression of the disease. These medications are usually recommended for people with Pagets disease who:
have bone pain, headache, back pain, or a nerve-related symptom (such as "shooting" pains in the leg) that is directly associated with the disease;
have elevated levels of serum alkaline phosphatase (ALP) in their blood;
display evidence that a bone fracture will occur;
require pretreatment therapy for affected bones that require surgery;
have active symptoms in the skull, long bones, or vertebrae (spine);
have the disease in bones located next to major joints, placing them at risk of developing osteoarthritis;
develop hypercalcemia that occurs when a person, with several bones affected by Pagets disease and a high serum alkaline phosphatase level, is immobilized. Bisphosphonates
Five bisphosphonates are currently available. In general, the most commonly prescribed are risedronic acid, alendronic acid, and pamidronic acid. Etidronic acid and other bisphosphonates may be appropriate therapies for selected patients but are less commonly used.
Signs and symptoms
Mild or early cases of Pagets are asymptomatic, and so most people are diagnosed with Pagets disease incidentally during medical evaluation for another problem. Approximately 35% of patients with Pagets have symptoms related to the disease when they are first diagnosed. Overall, the most common symptom is bone pain. When symptoms do occur, they may be confused with those of arthritis or other disorders, and so diagnosis may be delayed. Pagets may first be noticed as an increasing deformity of a persons bones.Pagets disease affecting the skull may cause frontal bossing, increased hat size, and headaches. Often patients may develop loss of hearing in one or both ears due to auditory foramen narrowing and resultant compression of the nerves in the inner ear. Rarely, skull involvement may lead to compression of the nerves that supply the eye, leading to vision loss. Associated conditions
Pagets disease is a frequent component of multisystem proteinopathy. Advanced Pagets disease may lead to other medical conditions, including:

Osteoarthritis may result from changes in bone shape that alter normal skeletal mechanics. For example, bowing of a femur affected by Pagets may distort overall leg alignment, subjecting the knee to abnormal mechanical forces and accelerating degenerative wear. Heart failure is a rare, reported consequence of severe Pagets disease (i.e. more than 40% skeletal involvement). The abnormal bone formation is associated with recruitment of abnormal blood vessels, forcing the cardiovascular system to work harder (pump more blood) to ensure adequate circulation. Kidney stones are somewhat more common in patients with Pagets disease.