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.
Fractures — Surgery may allow fractures to heal in a better position. 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 considered. Bone deformity — Cutting and realignment of pagetic bone (osteotomy) may help painful weight bearing joints, especially the knees.Complications resulting from enlargement of the skull or spine may injure the nervous system. However, most neurologic symptoms, even those that are moderately severe, can be treated with medication and do not require neurosurgery. Diet and exercise
In general, patients with Pagets disease should receive 1000–1500 mg of calcium, adequate sunshine, and at least 400 units of vitamin D daily. This is especially important in patients being treated with bisphosphonates; however, taking oral bisphosphonates should be separated from taking calcium by at least two hours, because the calcium can inhibit the absorption of the bisphosphonate. Patients with a history of kidney stones should discuss calcium and vitamin D intake with their physicians.Exercise is very important in maintaining skeletal health, avoiding weight gain, and maintaining joint mobility. Since undue stress on affected bones should be avoided, people with Pagets disease of bone should discuss any exercise program with their physicians or physical therapists before beginning. Prognosis
The disease is progressive and slowly worsens with time, although people may remain minimally symptomatic. Treatment is aimed at controlling symptoms, but there is no cure.