2. Paget’s Disease
Pathophysiology
• A chronic form of osteitis,
most commonly affecting
older people, causing
thickening and hypertrophy
of the long bones and
deformity of the flat bones.
• The bone is excessively
broken down (osteoclastic
activity) and re-formed
(osteoblastic activity). VIDEO
3. Interventions for Paget’s Disease
• Pain prevention
• Drug therapy
• Gentle massage
• Heat application
• ROM
• Fall Prevention r/t increased risk of bone fractures
• Use a cane or walker
• Remove rugs and floor coverings
• Install handrails
• Diet Modifications
• Increase calcium intake
• Increase vitamin D intake
• Promote reabsorption of calcium
4. Interventions for Paget’s Disease
• Smoking Cessation
• Smoking increases bone loss
• Avoid Excessive Alcohol
• Alcohol inhibits formation of bone
• Inhibits ability to absorb calcium
• Increased fall risk
• Exercise
• Maintains mobility and strength
• Talk to you doctor before beginning an
exercise plan because too much stress on
bones can cause excess damage
5. Assessment for Paget’s Disease
•80% of patient may be asymptomatic
•Ask about history of fracture and current bone
pain
•Hip and pelvis is the most common places where
pain occurs
•If the pain is radiating or throbbing pain
•Observe posture, stance, and gait
•Assess for kyphosis or scoliosis of the spinal
column
6. Assessment for Paget’s Disease
• Assess the shape and size of the skull (typically
soft, thick & enlarged)
• Patient may c/o of loss of hearing or vertigo
due to enlarged temporal bone
• Patient could have hydrocephalus due to
blocked CSF
• Assess skin for color and temerature
• Assess energy level
• Lab Tests (serum ALP, urinary hydroxproline,
calcium, uric acid)
• X-Rays, CT Scan, and MRI
7. Diagnosis
• Primary laboratory findings in Paget’s disease is
an increase in serum alkaline phosphatase (ALP)
and urinary hydroxyproline levels.
• Further evaluation of the ALP is done by
alkaline phosphatase isoenzymes, which helps
in a more defined diagnosis of the disease.
• Paget’s Disease elevates uric acid because of
nucleic acid from overactive bone metabolism is
increased.
8. Diagnosis
• X-rays show changes in the bone including:
osteolytic lesions, enlarged bones with
radiolucent, or punched out appearance.
• Radionuclide bone scans is most sensitive in
detecting this disease. Radiolabeled
biphosphate is administered through an IV
and can determine the extent of Paget’s
disease in the bone.
• CT’s are helpful in detecting changes in the
skull, changes in the spinal cord, and also
cancerous tumors.
9. Cultural Considerations
Both environmental and genetics contribute to
Paget’s disease, though the etiology is unknown.
Paget’s disease is most commonly found in:
Europe
North America
Australia
New Zealand
Paget’s disease is rarely found in Asia and Africa
10. Cultural Considerations
• In the United states, Paget’s disease is most
commonly found in white ethnicity
• Paget’s disease can be found all over the
world but is most often found in Europe
and Australia
• Affects an estimated 3% of people over the
age of 40
• The most popular descent with Paget’s
disease is Anglo-Saxon, this has led
researchers to think a genetic factor may be
important in the development of Paget’s
disease
11. Commonly Used Treatment
Methods For Paget’s Disease
•Although very different, many of the treatments for
Paget’s disease are also used to treat osteoporosis.
• The main goal in treating Paget’s is to relieve bone
pain and prevent the progression of the disease.
There are 3 Bisphosphonat
es
common ways
used to treat
Diet and
Paget’s: Surgery
Exercise
12. Bisphosphonates
Tablets Intravenous
*Etidronate disodium *Alendronate sodium *Pamidronate disodium
(Didronel) (Fosamax) (Aredia)
*Tiludronate disodium *Risendronate sodium *Zoledronic acid
(Skelid) (Actonel) (Reclast,Aclasta)
• Bisphosphonate tablets generally should be taken
with 6-8 ounces of tap water (not from a source with
high mineral content) on an empty stomach.
• None of these are recommended for people with
severe kidney disease.
13. Surgery
• *There are usually 3 major complications of
Paget’s when surgery may be recommended.
Fractures
• Surgery may allow bones to heal in a better position.
Severe
Degenerative
Arthritis
Bone Deformity
• The cutting and realignment of pagetic bone may help
painful weightbearing joints, especially the knees.
15. DIAGNOSIS
Disturbed body image r/t possible enlarged
head, bowed tibias, and kyphosis.
• Deficient knowledge r/t appropriate high in
protein and calcium, mild exercise.
Chronic sorrow r/t chronic condition with
altered body image.
• Risk for trauma: fracture r/t excessive bone
destruction.
16. Sources
• http://www.arthritis.ca/types%20of
%20arthritis/pagets/default.asp?
s=1&province=bc
• Ignatavicius. Medical-Surgical
Nursing, 6th edition. Pg 1162-1164
• Taber, C. W., & Thomas, C. L. (1997).
Taber's cyclopedic medical dictionary.
Philadelphia: F.A. Davis.
17. Teaching Plan
1. Patients over the age of 40 can be at risk for Paget’s disease.
2. Medical treatment may not cure current health problems associated with Paget’s
disease
3. Surgery may be needed to reduce pain and increase activity.
4. When taking oral medications, patients should drink 6-8 oz of water.
5. Patients should remain in an upright position 30 minutes following taking medications.
6. Patient should also refrain from eating for 30 minutes following oral medication
7. Patients may experience heartburn with oral medications.
8. Although the condition is a chronic illness, Paget’s disease focuses on the bones
associated with the spine, pelvic, hip, thighs, head and arms but does not spread to new
bone.
9. Patient needs to adhere to frequent, regular check-ups with treating physicians
10. Paget’s disease does not majorly impact the quality of patient life. Research shows
many have no critical complaints while living with Paget’s disease.
