Orthopedic management of Paget's disease of bone

The role of the orthopedic surgeon in the management of Paget's disease is in: evaluation and treatment of the cause of a patient's pain; evaluation of any deformities; treatment of fractures and tumors in affected bones. Pain due to active disease must be differentiated from nerve compression syndromes and arthritic pain because effective medical treatment is now available for pagetic bones. Spinal stenosis and sciatica are frequent in patients with Paget's desease because of vertebral body remodeling and collpase. Femoral and pelvic osseus pain may improve with treatment while an arthritic hip will remain symptomatic and require hip joint replacement. On one hand, bowed femora with inactive disease appear to be subject to an aching type of pain that does not respond well to antipagetic agents. On the other hand, for some unknown reason, tibial symptoms may respond dramatically to the same treatment. Biopsy is necessary only to exclude neoplastic transformation. Bone scans are useful to screen for distribution of the disease. The serum alkaline phosphatase and 24 hour urinary hydroxyproline determinations are the main indicators of the response of the disease to treatment.