Professional Bone

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Patients should remain upright for the next 30 minutes and should not eat, drink or take other medications until that time has passed. Any of these treatments can be repeated if necessary. Side effects of these medicines may involve heartburn and sometimes increasing bone pain for a short period of time. There are also injectable medications. Injectable medications that can be given for Paget's include:. Occasionally surgery is needed to help arthritis caused by the bone changes of Paget's disease and can be helpful in reducing pain and improving function.

Medical treatment is not expected to correct some of the changes of the Paget's disease that have already occurred, such as hearing loss, deformity or osteoarthritis. Paget's disease does not seriously affect quality of life and, for most people, the outcome is good. In fact, most people with Paget's disease of bone have no complaints.

Instead, it is the fast bone rebuilding that leads to complications such as bone pain, enlarged head, bowed arms or legs, arthritis osteoarthritis , back pain , loss of hearing, broken bones fractures , heart failure and, rarely, a form of bone cancer. This information is provided for general education only.

Professionals

Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition. Do you need help? Call Help Get more information. A physician needs to evaluate the condition to make sure there are no related problems.

Effective and safe treatment methods can help most people with Paget's disease.

Resources In This Article

What is Paget's disease? Excessive sun exposure does not result in vitamin D toxicity because the sustained heat on the skin is thought to photodegrade previtamin D 3 and vitamin D 3 as it is formed [ 6 ].

In addition, thermal activation of previtamin D 3 in the skin gives rise to various non-vitamin D forms that limit formation of vitamin D 3 itself. Some vitamin D 3 is also converted to nonactive forms [ 1 ]. Intakes of vitamin D from food that are high enough to cause toxicity are very unlikely. Toxicity is much more likely to occur from high intakes of dietary supplements containing vitamin D.

Long-term intakes above the UL increase the risk of adverse health effects [ 1 ] Table 4. Vitamin D supplements have the potential to interact with several types of medications. A few examples are provided below. Individuals taking these medications on a regular basis should discuss vitamin D intakes with their healthcare providers.

(Paget's Disease of Bone; Osteitis Deformans)

Corticosteroid medications such as prednisone, often prescribed to reduce inflammation, can reduce calcium absorption [ 68 , 69 , 70 ] and impair vitamin D metabolism. These effects can further contribute to the loss of bone and the development of osteoporosis associated with their long-term use [ 69 , 70 ].

The federal government's Dietary Guidelines for Americans notes that "Nutritional needs should be met primarily from foods. Foods in nutrient-dense forms contain essential vitamins and minerals and also dietary fiber and other naturally occurring substances that may have positive health effects. In some cases, fortified foods and dietary supplements may be useful in providing one or more nutrients that otherwise may be consumed in less-than-recommended amounts. For more information about building a healthy diet, refer to the Dietary Guidelines for Americans and the U.

Department of Agriculture's MyPlate. This fact sheet by the Office of Dietary Supplements ODS provides information that should not take the place of medical advice. We encourage you to talk to your healthcare providers doctor, registered dietitian, pharmacist, etc. Any mention in this publication of a specific product or service, or recommendation from an organization or professional society, does not represent an endorsement by ODS of that product, service, or expert advice.

March 2, History of changes to this fact sheet. Strengthening Knowledge and Understanding of Dietary Supplements. National Academy Press, Effectiveness and safety of vitamin D.

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Agency for Healthcare Research and Quality, Modern Nutrition in Health and Disease, 10th ed. Present Knowledge in Nutrition, 9th ed. Pharmacokinetics of vitamin D toxicity. Am J Clin Nutr ; N Engl J Med ; Clin Endocrinol Metab ; Assay variation confounds the diagnosis of hypovitaminosis D: J Clin Endocrinol Metab ; NIST releases vitamin D standard reference material , Department of Agriculture, Agricultural Research Service.

Nutrient Data Laboratory Home Page, http: Food contents and biological activity of hydroxyvitamin D: Ann Nutr Metab ; Vitamin D contents in edible mushrooms. J Agric Food Chem ; Vitamin D fortification in the United States and Canada: Analyzing vitamin D in foods and supplements: Including food hydroxyvitamin D in intake estimates may reduce the discrepancy between dietary and serum measures of vitamin D status.

Photobiology of vitamin D. Wolpowitz D, Gilchrest BA. The vitamin D questions: J Am Acad Dermatol ; Curr Opin Endocrinol Diabetes ;9: The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: Int J Cancer ; Position statement on vitamin D. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Estimation of total usual calcium and vitamin D intakes in the United States. Serum hydroxyvitamin D status of the US population: Nutrient composition of human milk. Pediatr Clin North Am ; Nutritional rickets among children in the United States: Vitamin D-deficiency rickets among children in Canada.

Influence of season and latitude on the cutaneous synthesis of vitamin D3: Exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin.

An evaluation of the relative contributions of exposure to sunlight and of diet to the circulating concentrations of hydroxyvitamin D in an elderly nursing home population in Boston. Vitamin D status in gastrointestinal and liver disease. Curr Opin Gastroenterol ; Recommended nutritional supplements for bariatric surgery patients. Vitamin D and the bariatric surgical patient: Evaluation, treatment, and prevention of vitamin D deficiency: Vitamin D and calcium: Occult vitamin D deficiency in postmenopausal US women with acute hip fracture.

Osteoporosis Handout on Health. American College of Obstetricians and Gynecologists. Hormone Therapy , April North American Menopause Society. The hormone therapy position statement of: The North American Menopause Society. Fall prevention with supplemental and active forms of vitamin D: Circulating hydroxyvitamin D levels and frailty status in older women. Vitamin D and cancer: A prospective nested case-control study of vitamin D status and pancreatic cancer risk in male smokers. Am J Epidemiol ; Risk factors for advanced colonic neoplasia and hyperplastic polyps in asymptomatic individuals.

Calcium plus vitamin D supplementation and the risk of colorectal cancer. Osteomalacia and related disorders. Metabolic bone disease and clinically related disorders. Prospective study of serum vitamin D and cancer mortality in the United States. J Natl Cancer Inst ; Association between pre-diagnostic circulating vitamin D concentration and risk of colorectal cancer in European populations: Intake of vitamin D and risk of type 1 diabetes: Vitamin D and calcium intake in relation to type 2 diabetes in women.

Amino-bisphosphonates are first-line therapy for Paget disease of bone, whereas the simple bisphosphonates bisphosphonates without an extra nitrogen atom are 2nd-line therapy. Synthetic salmon calcitonin is an alternative to bisphosphonates for patients intolerant of or resistant to them. For patients with contraindications to bisphosphonates, case reports suggest that denosumab may also be an alternative to bisphosphonates 4. Because bone turnover is increased, patients should ensure adequate intake of calcium and vitamin D, and supplements are often needed.

Taken as a single dose on an empty stomach at least 2 h before or after eating; can be repeated after a 3- to 6-mo interim if needed. For patients intolerant of oral bisphosphonates; possibly more frequent doses in patients with resistant disease. Dose sometimes tapered to 50 IU every other day and perhaps to twice or once weekly after a favorable initial response often after 1 mo. A single infusion of zoledronic acid produces sustained remissions in Paget disease: J Bone Miner Res 26 9: Treatment of Paget's disease of bone with denosumab: Case report and literature review.

Calcif Tissue Int 99 3: Paget disease of bone is a common and often asymptomatic abnormality, particularly among older adults. Complications can include osteoarthritis, fractures, neural compression, osteosarcoma, and rarely hypercalcemia. Complications of bisphosphonate treatment of Paget disease of bone include hyperparathyroidism and hypocalcemia. Confirmation is usually by x-rays showing findings such as bone sclerosis, coarse cortical trabeculation or cortical thickening, and bone bowing or enlargement.

First-line treatment is zolendronate or another amino-bisphosphonate alendronate , pamidronate , or risedronate. Results of which of the following tests may support the diagnosis of granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, or microscopic polyangiitis? Tap to switch to the Consumer Version. Paget Disease of Bone. This is the Professional Version. Click here for the Consumer Version.

The most common complication of Paget disease of bone is. Serum alkaline phosphatase, calcium, and phosphate PO 4. Paget disease should be suspected in patients with the following: Unexplained bone pain or deformity. Hypercalcemia that develops during bed rest, particularly among elderly patients. Characteristic x-ray findings include the following: Abnormal architecture with coarse cortical trabeculation or cortical thickening.

There may be lateral stress microfractures of the tibia or femur. Supportive care for symptoms and complications. Bisphosphonates if disease is symptomatic or active in bones at risk of complications. Drug therapy suppresses osteoclast activity. It is indicated for the following:

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