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Paget's disease, also known as deforming osteitis, is a metabolic bone disease, of unknown origin that usually affects the pelvic region, femur, tibia, spine vertebrae, clavicle and humerus. This disease is characterized by the destruction of bone tissue, which then recovers but with deformities. The new bone that is formed is structurally larger but weaker and with a lot of calcification.
It usually appears after 60 years of age, although from 40 there are already documented cases. It has a benign manifestation and most patients have no symptoms for a long time, and as it occurs most of the time in old age, the symptoms are often confused with other diseases such as arthritis or arthrosis that arises due to age.
Symptoms of Paget's disease
Most people who have Paget's disease do not show any signs or symptoms of alteration, discovering the disease during imaging tests to investigate another condition. On the other hand, some people can develop symptoms, the most common being pain in the bones at night.
The disease can be identified from the age of 40, being more frequent after the age of 60, and the symptoms are more related to the complications that can happen, the main ones being:
- Bone pain, especially in the legs;
- Joint deformity and pain;
- Deformation in the legs, leaving them arched;
- Frequent bone fractures;
- Increased curvature of the spine, leaving the person "hunchback";
- Osteoporosis;
- Arched legs;
- Deafness caused by enlarged skull bones.
Although the causes are not yet fully known, it is known that Paget's disease may be related to a latent viral infection, because in some cases viruses have been found in the affected bones. In addition, it is also known that Paget's disease can also be related to genetic factors and, therefore, people in the same family are more likely to develop the disease.
How the diagnosis is made
The diagnosis of Paget's disease must be made by the orthopedist initially by assessing the signs and symptoms presented by the person. However, to confirm the diagnosis, it is necessary to perform some imaging tests, such as X-rays and bone scans, in addition to laboratory tests, such as the measurement of calcium phosphorus and alkaline phosphatase in the blood. In Paget's disease, it is possible to observe that the calcium and potassium values are normal and the alkaline phosphatase is generally high.
In some cases, the doctor may also indicate the use of magnetic resonance imaging, in order to identify the possibility of sarcoma, giant cell tumor and metastasis, or tomorgafia to check the possibility of fracture.
Treatment for Paget's disease
Treatment for Paget's disease should be guided by the orthopedist according to the severity of the symptoms, and in some cases, the use of analgesics or anti-inflammatory drugs to relieve pain may be indicated, in addition to the use of modulators may also be recommended. bone activity in cases where the disease is most active.
In addition to medications, it is important to do physical therapy to control symptoms and improve the patient's quality of life. Surgery is the most appropriate treatment in cases of nerve compression or to replace a damaged joint.
1. Physiotherapy
Physiotherapy must be personally guided by a physiotherapist and must be individualized because each person must have their treatment appropriate to their needs, and stretching and muscle strengthening exercises can be indicated, which can be done with the use of devices such as waves short, infrared, ultrasound and TENS. Thus, through these exercises it is possible to avoid possible falls and fractures, since balance is also stimulated.
In addition, the physical therapist may also indicate physical exercises, in addition to physical therapy sessions, and the use of crutches or walkers to facilitate walking and reduce the risk of falls, in some cases.
Preferably, sessions should be held daily or at least 3 times a week to improve cardiovascular fitness, promote independence and improve quality of life. Although physical therapy is not able to cure Paget's disease, it is very important to decrease the motor complications imposed by the disease's progress.
2. Food
The nutritionist may recommend the consumption of foods rich in calcium and vitamin D to improve bone health, such as milk, cheese, yogurt, fish, eggs and seafood. These foods should be consumed daily, and skimmed milk products should preferably be chosen to avoid excess fat in the diet.
To increase the production of vitamin D in the body it is important to sunbathe for at least 20 minutes every day, without using sunscreen, as this vitamin is produced in the skin. In addition, regular physical activity helps to increase the absorption of calcium in the intestine and its fixation in the bones, helping to fight the disease.
See the video below for more tips to make bones stronger and avoid the signs and symptoms of Paget's disease:
3. Remedies
The remedies must be indicated by the doctor and can be taken daily or at certain times of the year, as needed. Some indicated are bisphosphonates in tablet or injection form such as alendronate, pamidronate, risedronate or zoledronic acid, or medications such as calcitonin, in addition to calcium carbonate tablets associated with cholecalciferol.
Affected people are usually followed up every 3 months so that the doctor can see if the drugs are working or if they need to be changed. When the person is more stable, follow-up can be done every 6 months or every year and must be maintained for a lifetime because the disease has no cure and can cause severe deformities.
4. Surgery
Normally, well-oriented physiotherapeutic treatment is capable of bringing numerous benefits to the person, postponing or avoiding surgery, however, it is necessary that the treatment is strictly followed.
Surgery can be an option when physical therapy is not enough to combat symptoms and deformities, when there is nerve compression or when the person needs to replace the joint and if there is severe degeneration that causes severe pain and blockage of movements.
The orthopedist can replace the joint and after this procedure it is necessary to return to physiotherapy to prevent complications and improve the range and strength of body movements, thus facilitating the person's daily life.