eMedicine Specialties > Physical Medicine and Rehabilitation > Medical Diseases

Paget Disease: Follow-up

Author: David Chow, MD, Medical Director, California Spine Center
Coauthor(s): Curtis W Slipman, MD, Director, University of Pennsylvania Spine Center; Associate Professor, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Medical Center; Debra Braverman, MD, Director of Alternative and Complementary Medicine, Assistant Professor, Department of Rehabilitation Medicine, University of Pennsylvania Health System
Contributor Information and Disclosures

Updated: Dec 18, 2008

Follow-up

Further Inpatient Care

  • Inpatient care may be necessary for individuals with Paget's disease who are experiencing intractable pain. Complications, such as fractures and neurologic compromise, necessitate inpatient monitoring and treatment.

Further Outpatient Care

  • Paget's disease can be managed in an outpatient setting.
    • Patient education about safety and awareness is important.
    • Home exercise and PT are important in maintaining skeletal health, avoiding weight gain, and maintaining joint mobility.
    • Nonsteroidal anti-inflammatory agents, simple analgesics, oral bisphosphonates, and calcitonin can be prescribed for patients for outpatient use. Intravenous doses of bisphosphonates can be administered in an outpatient clinic.
    • Untreated patients with mild disease should be scheduled for annual serum alkaline phosphatase levels and annual radiographs of osteolytic lesions.
    • Treated patients should have serum alkaline phosphatase levels every 3-4 months and should undergo annual radiographs of osteolytic lesions, if present. Alternatively, urinary hydroxyproline or collagen cross-links can be used.

Inpatient & Outpatient Medications

Transfer

  • Patients with Paget's disease usually are medically stable. Complications (such as neurologic compromise from spinal cord compression or hydrocephalus; brainstem compression from platybasia, basilar invagination, vertebral fracture, spinal stenosis) require transfer to the neurosurgical service. Neoplastic complications, such as pagetic sarcomas, may require surgical debridement, radiation, or chemotherapy, with subsequent transfer to an oncologic service.

Deterrence

  • No preventive programs exist for Paget's disease, because the etiology remains unknown. No long-term prospective studies have been conducted to support the preventive effects of chronic suppressive therapy on the risk of pagetic complications. If the patient has a family history of Paget's disease and is older than 40 years, he or she may wish to have an alkaline phosphatase blood test every 2-3 years. If the alkaline phosphatase level is within the reference range, radiography or bone scanning also may be performed.

Complications

Prognosis

  • The general outlook for patients with Paget's disease is good, especially if treatment is administered before major changes in the bones have occurred. Treatment does not cure Paget's disease, but it can control it. Patients with severe polyostotic Paget's disease have a less favorable prognosis than those with monostotic disease. Patients with polyostotic disease are at higher risk for complications.

Patient Education

  • Patient education about the pathophysiology of Paget's disease and its complications is critical. The patient needs to understand the importance of proper posture, body mechanics, and avoidance of trauma. Precautions against falling should be reinforced with the patient. At the same time, the hazards of immobility increase greatly with Paget's disease. The patient should understand that staying active still is essential.
  • Knowledge of the signs and symptoms of complications is important. For instance, increased local pain with soft-tissue mass should be reported to a physician immediately. Understanding the potential side effects of medications is helpful and reassuring to the patient. Patient education about delayed bone healing and the long rehabilitation process is important in situations of fracture and postsurgery. Reinforcement about the importance of careful, prolonged, protected weight bearing is crucial because the pagetic bone is abnormal and weak. Nonunion and refracture rates are high among patients with Paget's disease.
 


More on Paget Disease

Overview: Paget Disease
Differential Diagnoses & Workup: Paget Disease
Treatment & Medication: Paget Disease
Follow-up: Paget Disease
References
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References

  1. Paget J. On a form of chronic inflammation of bones. Medico-chirurgical Transactions. 1877;65:37-63.

  2. Altman RD, Bloch DA, Hochberg MC, et al. Prevalence of pelvic Paget's disease of bone in the United States. J Bone Miner Res. Mar 2000;15(3):461-5. [Medline].

  3. Guanabens N, Garrido J, Gobbo M, et al. Prevalence of Paget's disease of bone in Spain. Bone. Aug 16 2008;[Medline].

  4. Barker DJ, Chamberlain AT, Guyer PB, et al. Paget's disease of bone: the Lancashire focus. Br Med J. Apr 26 1980;280(6222):1105-7. [Medline]. [Full Text].

  5. Cooper C, Dennison E, Schafheutle K, et al. Epidemiology of Paget's disease of bone. Bone. May 1999;24(5 Suppl):3S-5S. [Medline].

  6. Doyle T, Gunn J, Anderson G, et al. Paget's disease in New Zealand: evidence for declining prevalence. Bone. Nov 2002;31(5):616-9. [Medline].

  7. Rebel A, Basle M, Pouplard A, et al. Towards a viral etiology for Paget's disease of bone. Metab Bone Dis Relat Res. 1981;3(4-5):235-8. [Medline].

  8. Alvarez L, Guañabens N, Peris P, et al. Discriminative value of biochemical markers of bone turnover in assessing the activity of Paget's disease. J Bone Miner Res. Mar 1995;10(3):458-65. [Medline].

  9. Drake MT, Clarke BL, Khosla S. Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin Proc. Sep 2008;83(9):1032-45. [Medline].

  10. Lluberas-Acosta G, Hansell JR, Schumacher HR Jr. Paget's disease of bone in patients with gout. Arch Intern Med. Dec 1986;146(12):2389-92. [Medline].

  11. Seitz S, Priemel M, Zustin J, et al. Paget's disease of bone - histologic analysis of 754 patients. J Bone Miner Res. Sep 3 2008;[Medline].

  12. Dove J. Complete fractures of the femur in Paget's disease of bone. J Bone Joint Surg Br. Feb 1980;62-B(1):12-7. [Medline]. [Full Text].

  13. Goldman AB, Bullough P, Kammerman S, et al. Osteitis deformans of the hip joint. AJR Am J Roentgenol. Apr 1977;128(4):601-6. [Medline].

  14. Silverman SL. Paget disease of bone: therapeutic options. J Clin Rheumatol. Oct 2008;14(5):299-305. [Medline].

  15. Abelson A. A review of Paget's disease of bone with a focus on the efficacy and safety of zoledronic acid 5 mg. Curr Med Res Opin. Mar 2008;24(3):695-705. [Medline].

  16. Woitge HW, Oberwittler H, Heichel S, et al. Short- and long-term effects of ibandronate treatment on bone turnover in Paget disease of bone. Clin Chem. May 2000;46(5):684-90. [Medline]. [Full Text].

  17. González DC, Mautalen CA. Short-term therapy with oral olpadronate in active Paget's disease of bone. J Bone Miner Res. Dec 1999;14(12):2042-7. [Medline].

  18. Miller PD, Brown JP, Siris ES, et al. A randomized, double-blind comparison of risedronate and etidronate in the treatment of Paget's disease of bone. Paget's Risedronate/Etidronate Study Group. Am J Med. May 1999;106(5):513-20. [Medline].

  19. Roux C, Gennari C, Farrerons J, et al. Comparative prospective, double-blind, multicenter study of the efficacy of tiludronate and etidronate in the treatment of Paget's disease of bone. Arthritis Rheum. Jun 1995;38(6):851-8. [Medline].

  20. Siris E, Weinstein RS, Altman R, et al. Comparative study of alendronate versus etidronate for the treatment of Paget's disease of bone. J Clin Endocrinol Metab. Mar 1996;81(3):961-7. [Medline].

  21. Selby PL, Davie MW, Ralston SH, et al. Guidelines on the management of Paget's disease of bone. Bone. Sep 2002;31(3):366-73. [Medline].

  22. Altman RD, Brown M, Gargano F. Low back pain in Paget's disease of bone. Clin Orthop Relat Res. Apr 1987;(217):152-61. [Medline].

  23. Anderson DC, Richardson PC, Brown JK, et al. Intravenous pamidronate: evolution of an effective treatment strategy. Semin Arthritis Rheum. Feb 1994;23(4):273-5. [Medline].

  24. Arnalich F, Plaza I, Sobrino JA, et al. Cardiac size and function in Paget's disease of bone. Int J Cardiol. Apr 1984;5(4):491-505. [Medline].

  25. Avioli LV, Krane SM, eds. Metabolic Bone Disease and Clinically Related Disorders. 3rd ed. Philadelphia, Pa: WB Saunders; 1990:546-615.

  26. Barker DJ, Clough PW, Guyer PB, et al. Paget's disease of bone in 14 British towns. Br Med J. May 7 1977;1(6070):1181-3. [Medline]. [Full Text].

  27. Berg C, Hanebuth L. Paget's disease. Nurs Care. Apr 1977;10(4):25-6. [Medline].

  28. Braddom, RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996:813-75, 1237-50.

  29. Buckler H, Fraser W, Hosking D, et al. Single infusion of zoledronate in Paget's disease of bone: a placebo-controlled, dose-ranging study. Bone. May 1999;24(5 Suppl):81S-85S. [Medline].

  30. Chakravarty K, Merry P, Scott DG. A single infusion of bisphosphonate AHPrBP in the treatment of Paget's disease of bone. J Rheumatol. Nov 1994;21(11):2118-21. [Medline].

  31. Chen JR, Rhee RS, Wallach S, et al. Neurologic disturbances in Paget disease of bone: response to calcitonin. Neurology. Apr 1979;29(4):448-57. [Medline].

  32. Clarke PR, Williams HI. Ossification in extradural fat in Paget's disease of the spine. Br J Surg. Jul 1975;62(7):571-2. [Medline].

  33. Collins DH. Paget's disease of bone; incidence and subclinical forms. Lancet. Jul 14 1956;271(6933):51-7. [Medline].

  34. Cooper C, Schafheutle K, Dennison E, et al. The epidemiology of Paget's disease in Britain: is the prevalence decreasing?. J Bone Miner Res. Feb 1999;14(2):192-7. [Medline].

  35. Cotran RS, Kumar V, Robbins SL. Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, Pa: WB Saunders; 1994:1223-4.

  36. Crisp AJ, Smith ML, Skingle SJ, et al. The localization of the bone lesions of Paget's disease by radiographs, scintigraphy and thermography: pain may be related to bone blood flow. Br J Rheumatol. Jun 1989;28(3):266-8. [Medline].

  37. Damjanov I, Linder J, eds. Anderson's Pathology. vol 2. 10th ed. St Louis, Mo: Mosby; 1996:2606-7.

  38. Davies DG. Paget's disease of the temporal bone. A clinical and histopathological survey. Acta Otolaryngol. 1968;(Suppl 242):3+. [Medline].

  39. Degroot LJ, et al, eds. Endocrinology. vol 2. 3rd ed. Philadelphia, Pa: WB Saunders; 1995:1259-73.

  40. Delisa J, ed. Rehabilitation Medicine: Principles and Practice. Philadelphia, Pa: WB Saunders; 1998:1423-76.

  41. Delmas PD. Biochemical markers of bone turnover in Paget's disease of bone. J Bone Miner Res. Oct 1999;14(Suppl 2):66-9. [Medline].

  42. Dickinson CJ. The possible role of osteoclastogenic oral bacterial products in etiology of Paget's disease. Bone. Feb 2000;26(2):101-2. [Medline].

  43. Durán A, Serrano M, Leitges M, et al. The atypical PKC-interacting protein p62 is an important mediator of RANK-activated osteoclastogenesis. Dev Cell. Feb 2004;6(2):303-9. [Medline].

  44. el Sammaa M, Linthicum FH Jr, House HP, et al. Calcitonin as treatment for hearing loss in Paget's disease. Am J Otol. Jul 1986;7(4):241-3. [Medline].

  45. Eretto P, Krohel GB, Shihab ZM, et al. Optic neuropathy in Paget's disease. Am J Ophthalmol. Apr 1984;97(4):505-10. [Medline].

  46. Füessl HS. [Optimizing therapy in Paget disease]. MMW Fortschr Med. Dec 15 2005;147(51-52):32. [Medline].

  47. Garnero P, Gineyts E, Schaffer AV, et al. Measurement of urinary excretion of nonisomerized and beta-isomerized forms of type I collagen breakdown products to monitor the effects of the bisphosphonate zoledronate in Paget's disease. Arthritis Rheum. Feb 1998;41(2):354-60. [Medline].

  48. Genuth SM, Klein L. Hypoparathyroidism and Paget's disease: the effect of parathyroid hormone administration. J Clin Endocrinol Metab. Nov 1972;35(5):693-9. [Medline].

  49. Grauer A, Bone H, McCloskey EV, et al. Discussion: Newer bisphosphonates in the treatment of Paget's disease of bone: where we are and where we want to go. J Bone Miner Res. Oct 1999;14(Suppl 2):74-8. [Medline].

  50. Grauer A, Heichel S, Knaus J, et al. Ibandronate treatment in Paget's disease of bone. Bone. May 1999;24(5 Suppl):87S-89S. [Medline].

  51. Hadjipavlou A, Lander P. Paget disease of the spine. J Bone Joint Surg [Am]. Oct 1991;73(9):1376-81. [Medline].

  52. Hadjipavlou A, Lander P, Srolovitz H, et al. Malignant transformation in Paget disease of bone. Cancer. Dec 15 1992;70(12):2802-8. [Medline].

  53. Hamdy RC. Paget's Disease of Bone: Assessment and Management. New York, NY: Praeger Publishers; 1981.

  54. Harrington KD. Surgical management of neoplastic complications of Paget's disease. J Bone Miner Res. Oct 1999;14(Suppl 2):45-8. [Medline].

  55. Hartman JT, Dohn DF. Paget's disease of the spine with cord or nerve-root compression. J Bone Joint Surg Am. Sep 1966;48(6):1079-84. [Medline].

  56. Hocking LJ, Lucas GJ, Daroszewska A, et al. Domain-specific mutations in sequestosome 1 (SQSTM1) cause familial and sporadic Paget's disease. Hum Mol Genet. Oct 15 2002;11(22):2735-9. [Medline].

  57. Hocking LJ, Lucas GJ, Daroszewska A, et al. Novel UBA domain mutations of SQSTM1 in Paget's disease of bone: genotype phenotype correlation, functional analysis, and structural consequences. J Bone Miner Res. Jul 2004;19(7):1122-7. [Medline].

  58. Huvos AG. Osteogenic sarcoma of bones and soft tissues in older persons. A clinicopathologic analysis of 117 patients older than 60 years. Cancer. Apr 1 1986;57(7):1442-9. [Medline].

  59. Jaffe HL. Metabolic, Degenerative and Inflammatory Diseases of Bones and Joints. Philadelphia, Pa: Lea & Febiger; 1972:240.

  60. Kanis JA. Pathophysiology and Treatment of Paget's Disease of Bone. London, England: Martin Dunitz; 1998:99.

  61. Kaplan FS. Surgical management of Paget's disease. J Bone Miner Res. Oct 1999;14(Suppl 2):34-8. [Medline].

  62. Kaplan FS, Haddad JG, Singer FR. Paget's disease: complications and controversies. Calcif Tissue Int. Aug 1994;55(2):75-8. [Medline].

  63. Kelly WH, Harris ED Jr. Textbook of Rheumatology. vol 2. 5th ed. Philadelphia, Pa: WB Saunders; 1997:1574-77.

  64. Khairi MR, Altman RD, DeRosa GP, et al. Sodium etidronate in the treatment of Paget's disease of bone. A study of long-term results. Ann Intern Med. Dec 1977;87(6):656-63. [Medline].

  65. Khairi MR, Wellman HN, Robb JA, et al. Paget's disease of bone (osteitis deformans): symptomatic lesions and bone scan. Ann Intern Med. Sep 1973;79(3):348-51. [Medline].

  66. Laurin N, Brown JP, Morissette J, et al. Recurrent mutation of the gene encoding sequestosome 1 (SQSTM1/p62) in Paget disease of bone. Am J Hum Genet. Jun 2002;70(6):1582-8. [Medline]. [Full Text].

  67. Lindsay JR, Lehman RH. Histopathology of the temporal bone in advanced Paget's disease. Laryngoscope. Feb 1969;79(2):213-27. [Medline].

  68. Ludkowski P, Wilson-MacDonald J. Total arthroplasty in Paget's disease of the hip. A clinical review and review of the literature. Clin Orthop. Jun 1990;(255):160-7. [Medline].

  69. Lyles KW, Siris ES, Singer FR, et al. A clinical approach to diagnosis and management of Paget's disease of bone. J Bone Miner Res. Aug 2001;16(8):1379-87. [Medline].

  70. McClung MR, Tou CK, Goldstein NH, et al. Tiludronate therapy for Paget's disease of bone. Bone. Nov 1995;17(5 Suppl):493S-496S. [Medline].

  71. McKusick VA. Heritable Disorders of Connective Tissue. 4th ed. St Louis, Mo: Mosby; 1972.

  72. Meunier PJ. Paget's disease: treatment results and expectations with present therapies. J Bone Miner Res. Oct 1999;14(Suppl 2):70-3. [Medline].

  73. Meunier PJ, Salson C, Mathieu L, et al. Skeletal distribution and biochemical parameters of Paget's disease. Clin Orthop Relat Res. Apr 1987;37-44. [Medline].

  74. Meunier PJ, Vignot E. Therapeutic strategy in Paget's disease of bone. Bone. Nov 1995;17(5 Suppl):489S-491S. [Medline].

  75. Meyers MH, Singer FR. Osteotomy for tibia vara in Paget's disease under cover of calcitonin. J Bone Joint Surg [Am]. Sep 1978;60(6):810-4. [Medline].

  76. Milgram JW. Orthopedic management of Paget's disease of bone. Clin Orthop Relat Res. 1977;(127):63-9. [Medline].

  77. Mirón-Canelo JA, Del Pino-Montes J, Vicente-Arroyo M, et al. Epidemiological study of Paget's disease of bone in a zone of the Province of Salamanca (Spain). The Paget's disease of the bone study group of Salamanca. Eur J Epidemiol. Oct 1997;13(7):801-5. [Medline].

  78. Montagu MFA. Paget's disease (osteitis deformans) and hereditary. Am J Hum Gene. 1949;1:94-5.

  79. Morales-Piga AA, Rey-Rey JS, Corres-González J, et al. Frequency and characteristics of familial aggregation of Paget's disease of bone. J Bone Miner Res. Apr 1995;10(4):663-70. [Medline].

  80. Nagant de Deuxchaisnes C, Krane SM. Paget's disease of bone: clinical and metabolic observations. Medicine (Baltimore). May 1964;43:233-66. [Medline].

  81. Nagant de Deuxchaisnes CN, Maldague B, Malghem J, et al. The action of the main therapeutic regimes on Paget's disease of bone with a note on the effect of Vitamin D deficiency. Arthritis Rheum. 1980;23:1215-34.

  82. Nager GT. Paget's disease of the temporal bone. Ann Otol Rhinol Laryngol. Jul-Aug 1975;84(4 Pt 3 Suppl 22):1-32. [Medline].

  83. O'Doherty DP, Bickerstaff DR, McCloskey EV, et al. Treatment of Paget's disease of bone with aminohydroxybutylidene bisphosphonate. J Bone Miner Res. May 1990;5(5):483-91. [Medline].

  84. Maddison PJ, ed. Oxford Textbook of Rheumatology. vol 2. 2nd ed. Oxford, England: Blackwell Science; 1998:1610-17.

  85. Papapoulos SE, Hoekman K, Löwik CW, et al. Application of an in vitro model and a clinical protocol in the assessment of the potency of a new bisphosphonate. J Bone Miner Res. Oct 1989;4(5):775-81. [Medline].

  86. Posen S. Paget's disease: current concepts. Aust N Z J Surg. Jan 1992;62(1):17-23. [Medline].

  87. Potter HG, Schneider R, Ghelman B, et al. Multiple giant cell tumors and Paget disease of bone: radiographic and clinical correlations. Radiology. Jul 1991;180(1):261-4. [Medline].

  88. Price CH, Goldie W. Paget's sarcoma of bone. A study of eighty cases from the Bristol and the Leeds bone tumour registries. J Bone Joint Surg Br. May 1969;51(2):205-24. [Medline]. [Full Text].

  89. Pygott F. Paget's disease of bone; the radiological incidence. Lancet. Jun 8 1957;272(6980):1170-1. [Medline].

  90. Reginster JY, Colson F, Morlock G, et al. Evaluation of the efficacy and safety of oral tiludronate in Paget's disease of bone. A double-blind, multiple-dosage, placebo-controlled study. Arthritis Rheum. Aug 1992;35(8):967-74. [Medline].

  91. Reid IR, Nicholson GC, Weinstein RS, et al. Biochemical and radiologic improvement in Paget's disease of bone treated with alendronate: a randomized, placebo-controlled trial. Am J Med. Oct 1996;101(4):341-8. [Medline].

  92. Resnick D. Diagnosis of Bone and Joint Disorders. vol 4. 3rd ed. Philadelphia, Pa: WB Saunders; 1995:1923-68.

  93. Resnick D. Patterns of migration of the femoral head in osteoarthritis of the hip. Roentgenographic-pathologic correlation and comparison with rheumatoid arthritis. Am J Roentgenol Radium Ther Nucl Med. May 1975;124(1):62-74. [Medline].

  94. Roodman GD, Windle JJ. Paget disease of bone. J Clin Invest. Feb 2005;115(2):200-8. [Medline]. [Full Text].

  95. Russell RG, Rogers MJ, Frith JC, et al. The pharmacology of bisphosphonates and new insights into their mechanisms of action. J Bone Miner Res. Oct 1999;14(Suppl 2):53-65. [Medline].

  96. Schmorl G. Ueber ostitis deformans paget. Virchows Arch (Pathol Anat). 1932;283:694.

  97. Schweitzer DH, Zwinderman AH, Vermeij P, et al. Improved treatment of Paget's disease with dimethylaminohydroxypropylidene bisphosphonate. J Bone Miner Res. Feb 1993;8(2):175-82. [Medline].

  98. Singer FR, Wallach S. Paget's Disease of Bone: Clinical Assessment, Present and Future Therapy. New York, NY: Elsevier; 1991:86-99.

  99. Siris ES. Perspectives: a practical guide to the use of pamidronate in the treatment of Paget's disease. J Bone Miner Res. Mar 1994;9(3):303-4. [Medline].

  100. Siris ES, Ottman R, Flaster E, et al. Familial aggregation of Paget's disease of bone. J Bone Miner Res. May 1991;6(5):495-500. [Medline].

  101. Smith J, Botet JF, Yeh SD. Bone sarcomas in Paget disease: a study of 85 patients. Radiology. Sep 1984;152(3):583-90. [Medline].

  102. Sofaer JA, Holloway SM, Emery AE. A family study of Paget's disease of bone. J Epidemiol Community Health. Sep 1983;37(3):226-31. [Medline].

  103. Suda T, Takahashi N, Udagawa N, et al. Modulation of osteoclast differentiation and function by the new members of the tumor necrosis factor receptor and ligand families. Endocr Rev. Jun 1999;20(3):345-57. [Medline]. [Full Text].

  104. Taylor S. Endocrinology. London, England: W Heinemann; 1974:409-24.

  105. Tilyard MW, Gardner RJ, Milligan L, et al. A probable linkage between familial Paget's disease and the HLA loci. Aust N Z J Med. Oct 1982;12(5):498-500. [Medline].

  106. Uebelhart D, Gineyts E, Chapuy MC, et al. Urinary excretion of pyridinium crosslinks: a new marker of bone resorption in metabolic bone disease. Bone Miner. Jan 1990;8(1):87-96. [Medline].

  107. van Staa TP, Selby P, Leufkens HG, et al. Incidence and natural history of Paget's disease of bone in England and Wales. J Bone Miner Res. Mar 2002;17(3):465-71. [Medline].

  108. Vega E, Mautalen C, Roldán EJ, et al. Preliminary study of multiple increasing oral doses of dimethyl-APD on bone metabolism dynamics and safety profile. Drugs Exp Clin Res. 1994;20(3):103-8. [Medline].

  109. Vellenga CJ, Pauwels EK, Bijvoet OL. Some characteristics of local scintigraphic and radiologic patterns of Paget's disease of bone (osteitis deformans). Diagn Imaging Clin Med. 1985;54(5):273-81. [Medline].

  110. Vellenga CJ, Pauwels EK, Bijvoet OL. Untreated Paget disease of bone studied by scintigraphy. Radiology. Dec 1984;153(3):799-805. [Medline].

  111. Wallace E, Wong J, Reid IR. Pamidronate treatment of the neurologic sequelae of pagetic spinal stenosis. Arch Intern Med. Sep 11 1995;155(16):1813-5. [Medline].

  112. Wallach S, Siris E, Singer F, et al. Risedronate produces sustained remission in patients with Paget's disease. Bone. 1998;23(5 Suppl):S454.

  113. Walsh JP. Paget's disease of bone. Med J Aust. Sep 6 2004;181(5):262-5. [Medline]. [Full Text].

  114. Walsh JP, Ward LC, Stewart GO, et al. A randomized clinical trial comparing oral alendronate and intravenous pamidronate for the treatment of Paget's disease of bone. Bone. Apr 2004;34(4):747-54. [Medline].

  115. Waltner JG. Stapedectomy in Paget's disease. Histological and clinical studies. Arch Otolaryngol. Oct 1965;82(4):355-8. [Medline].

  116. Watts RA, Skingle SJ, Bhambhani MM, et al. Treatment of Paget's disease of bone with single dose intravenous pamidronate. Ann Rheum Dis. Aug 1993;52(8):616-8. [Medline]. [Full Text].

  117. Wimalawansa SJ, Gunasekera RD. Pamidronate is effective for Paget's disease of bone refractory to conventional therapy. Calcif Tissue Int. Oct 1993;53(4):237-41. [Medline].

  118. Woodhouse NJ, Crosbie WA, Mohamedally SM. Cardiac output in Paget's disease: response to long-term salmon calcitonin therapy. Br Med J. Dec 20 1975;4(5998):686. [Medline]. [Full Text].

  119. Wootton R, Reeve J, Veall N. The clinical measurement of skeletal blood flow. Clin Sci Mol Med. Apr 1976;50(4):261-8. [Medline].

  120. Wootton R, Tellez M, Green JR, et al. Skeletal blood flow in Paget's disease of bone. Metab Bone Dis Relat Res. 1981;3(4-5):263-70. [Medline].

  121. Yochum TR. Paget's sarcoma of bone. Radiologe. Sep 1984;24(9):428-33. [Medline].

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Further Reading

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Keywords

Paget disease, Paget's disease, bone pain, bone disease, Paget's disease of bone, Paget's bone disease, osteoblast, osteoclast, osteoblasts, osteoclasts, osteoblastic, Paget disease of bone, osteitis deformans, osteoclastic, bone deformity

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Contributor Information and Disclosures

Author

David Chow, MD, Medical Director, California Spine Center
David Chow, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Society of Interventional Pain Physicians, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Coauthor(s)

Curtis W Slipman, MD, Director, University of Pennsylvania Spine Center; Associate Professor, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Medical Center
Curtis W Slipman, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, International Association for the Study of Pain, and North American Spine Society
Disclosure: Nothing to disclose.

Debra Braverman, MD, Director of Alternative and Complementary Medicine, Assistant Professor, Department of Rehabilitation Medicine, University of Pennsylvania Health System
Debra Braverman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Medical Editor

Patrick J Potter, BSc, MD, FRCP(C), Associate Professor, Physical Medicine and Rehabilitation, The University of Western Ontario; Consulting Staff, Department of Physical Medicine and Rehabilitation, St Joseph's Health Care Centre
Patrick J Potter, BSc, MD, FRCP(C) is a member of the following medical societies: American Paraplegia Society, Canadian Association of Physical Medicine and Rehabilitation, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Kat Kolaski, MD, Assistant Professor, Departments of Orthopedic Surgery and Pediatrics, Wake Forest University School of Medicine
Kat Kolaski, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine and American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Denise I Campagnolo, MD, MS, Director of Multiple Sclerosis Clinical Research and Staff Physiatrist, Barrow Neurology Clinics, St Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics; Director, NARCOMS Project for Consortium of MS Centers
Denise I Campagnolo, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, and Consortium of Multiple Sclerosis Centers
Disclosure: Teva Neuroscience Honoraria Speaking and teaching; Serono-Pfizer Honoraria Speaking and teaching

 
 
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