If you don't have symptoms, you might not need treatment. However, if the disease is active — indicated by an elevated alkaline phosphatase level — and is affecting high-risk sites in your body, such as your skull or spine, your doctor might recommend treatment to prevent complications, even if you don't have symptoms.
Osteoporosis drugs (bisphosphonates) are the most common treatment for Paget's disease of bone. Bisphosphonates are typically given by injection into a vein, but they can also be taken by mouth. When taken orally, bisphosphonates are generally well tolerated but can irritate the stomach.
Bisphosphonates that are given intravenously include:
- Zoledronic acid (Zometa, Reclast)
- Pamidronate (Aredia)
- Ibandronate (Boniva)
Oral bisphosphonates include:
- Alendronate (Fosamax, Binosto)
- Risedronate (Actonel, Atelvia)
Rarely, bisphosphonate therapy has been linked to severe muscle, joint or bone pain, which might not resolve when the medication is discontinued. Bisphosphonates can also increase the risk of a rare condition in which a section of jawbone dies and deteriorates, usually associated with active dental disease or oral surgery.
If you can't tolerate bisphosphonates, your doctor might prescribe calcitonin (Miacalcin), a naturally occurring hormone involved in calcium regulation and bone metabolism. Calcitonin is a drug that you administer to yourself by injection or nasal spray. Side effects may include nausea, facial flushing and irritation at the injection site.
In rare cases, surgery might be required to:
- Help fractures heal
- Replace joints damaged by severe arthritis
- Realign deformed bones
- Reduce pressure on nerves
Paget's disease of bone often causes the body to produce too many blood vessels in the affected bones, increasing the risk of serious blood loss during an operation.
If you're scheduled for surgery that involves bones affected by Paget's disease of bone, your doctor might prescribe medications to reduce the activity of the disease, which may help reduce blood loss during surgery.