Topic Overview
What is Paget's disease?
Paget's disease is a long-lasting (chronic) condition that causes
abnormal
bone growth. Bone is constantly being replaced as bone
tissue is broken down and absorbed into the body, then rebuilt with new cells.
In the early stages of Paget's disease, bone tissue is broken down and absorbed
much faster than normal. To keep up with the rapid breakdown of bone tissue,
the body speeds up the bone rebuilding process. But this new bone is often weak
and brittle, causing it to break (fracture) more easily.
Paget's disease usually affects the bones in the
pelvis,
spine, thigh (femur), skull, shin (tibia), and upper
arm (humerus). One bone or several bones may be affected by
Paget's disease.
What causes Paget's disease?
The cause of Paget's disease is not clear.
Genetic factors and viruses may play a role in the
development of the disease.
What are the symptoms?
Most people with Paget's disease have no symptoms. When symptoms
are present, the most common are bone pain, deformed bones (bowed legs,
enlarged skull or hips, or a curved backbone), and
fractures. Because the bone pain may be aching and
hard to describe, you may think it is part of the aging process.
Other symptoms may occur as the result of the location of Paget's
disease. For example, the disease can affect the skull and cause headaches,
dizziness, loss of muscle strength in the face (facial droop),
or problems with vision or hearing. When the disease affects the spine, nerves
can become damaged and cause leg pain, numbness, weakness, or
cauda equina syndrome (an emergency condition with
symptoms that include loss of feeling in the pelvic area and legs).
How is Paget's disease diagnosed?
Most often, Paget's disease is discovered when you see a doctor or
nurse for a different reason, such as hip or back pain. A bone X-ray or a blood
test with above-normal levels of the
enzyme alkaline phosphatase often leads to the
discovery of the disease. Doctors usually diagnose Paget's disease based on
your medical history, a physical exam, bone X-rays, lab tests, and possibly a
bone scan.
How is it treated?
Paget's disease is treated with medicines that slow the rapid
breakdown of bone tissue. You might also take medicines to relieve pain. You
may need treatment to try to prevent complications such as
osteoarthritis even if you do not yet have symptoms of
Paget's disease. Later in the disease process, you may need surgery to replace
a hip or knee joint damaged by the disease.
Learning about Paget's disease: | |
Being diagnosed: | |
Getting treatment: | |
Living with Paget's disease: | |
Cause
We don't know what causes
Paget's disease. But
genetic factors and
viruses may play a role.
- Genetics. If your parents, brothers, or sisters
have Paget's disease, you are more likely to develop the disease than if you do
not have a family history of the disease.1
- Virus. Viruses have been found in the bones of people with Paget's
disease. The viruses may be associated with
measles or canine distemper (found in dogs).2 But there is no proof that any of these viruses cause Paget's
disease.
Symptoms
Most people with
Paget's disease have no symptoms. When there are
symptoms, the most common are
bone pain and bone deformities. People may have these
symptoms for years before they are diagnosed as having Paget's disease.
Paget's disease usually affects the bones in the
pelvis,
spine, thigh (femur), skull, shin (tibia), and upper
arm (humerus). One bone (monostotic) or several bones
(polyostotic) may be affected by Paget's disease.
Bone pain
Paget's disease may cause warmth, tenderness, and pain in the
affected area. The bone pain tends to be worse at night and often can keep you
awake. The pain does not increase when you move the affected bone and may get
better with exercise. Because this pain is often aching and hard to describe,
you may think it is part of the aging process. Some people who have Paget's disease
describe the pain as constant and deep.
The amount of bone pain may not relate to how much damage the
disease is causing. You can have Paget's disease without having much bone pain,
or the disease may be less severe but cause you a great deal of pain. Bones are
often more painful when bone tissue is being broken down during
active Paget's disease than at other times in the
disease process. Pain may also be caused by a
complication of Paget's disease, such as
arthritis.
Bone deformities
Paget's disease may lead to bone deformities such as
bowed legs, an enlarged skull or hips, or a curved backbone. Deformities are
more common in long bones, such as the thighbone (femur).
A bone affected by Paget's disease can cause complications. For
example, if the upper leg bows, it may change how the bones that form the hip
joint and knee joint fit together and move, leading to
osteoarthritis. Osteoarthritis, in turn, can cause
pain and stiffness in the joints and difficulty with walking and other daily
activities.
Other symptoms may occur as the result of the location of Paget's
disease. For example, the disease can affect the skull and cause headaches,
dizziness, loss of facial muscle strength (facial droop),
or problems with vision or hearing. When Paget's disease affects the spine, it
can damage nerves and cause leg pain, numbness, weakness, or
cauda equina syndrome (an emergency condition with
symptoms that include loss of feeling in the pelvic area and legs).
What Happens
In healthy people,
bone is constantly being replaced as bone tissue is
broken down and absorbed into the body, then rebuilt with new cells. In the
early stages of
Paget's disease, bone tissue breaks down faster than
it rebuilds. To make up for this breakdown process, the body speeds up the
rebuilding process. But this new bone is often weak and brittle, causing it to
break (fracture) more easily. Your body also tends to produce too much of this
new bone, and the bone may have more blood supply than normal.
Paget's disease usually affects the bones in the
pelvis,
spine, thigh (femur), skull, shin (tibia), and upper
arm (humerus). Paget's disease may affect just one bone
(monostotic), but it usually affects more than one (polyostotic).
Early in Paget's
disease, you may not know that you have it. People often mistake symptoms such
as bone pain for normal aging or
osteoarthritis. Later in the disease, you may have
signs such as
bowed legs, enlarged skull or facial bones, stooped-forward posture, or broken
bones (fractures).
Paget's disease is a lifelong illness and can be either
active or inactive at different times. Paget's disease
rarely spreads to additional bones after it gets started. Most people who have
Paget's disease lead normal lives.
Complications of Paget's disease are rare but may
include inflammation of joints (arthritis),
broken bones (fractures),
heart failure, and nerve problems. Nerve problems can
cause a variety of symptoms, such as headache,
dizziness,
hearing loss, and vision problems.
What Increases Your Risk
Things that increase your risk for
Paget's disease include:
- Family history. If your parents, brothers, or
sisters have Paget's disease, you are more likely to develop the disease than
if no one in your family has it.
- Age. Paget's disease is most common in people older
than 50 and is unusual in people younger than 40.2
When To Call a Doctor
Call your doctor immediately if you have
Paget's disease and you notice signs of
complications, such as:
- Sudden hearing or vision loss. As the bones in
the head enlarge from Paget's disease, nerve damage can occur and can lead to
permanent loss of hearing or vision.
- Weakness or numbness in your
face. As the bones in the head enlarge from Paget's disease, they can damage
the nerves in the face.
- Shortness of breath or severe swelling,
particularly in the legs or the abdomen. This could also be a sign of
heart failure.
- Weakness in both legs with loss of
bladder or
bowel control. This is a symptom of a specific type of
nerve root pressure (compression) called
cauda equina syndrome, which can result from rapid
bone growth putting pressure on nerves from the spinal cord. This is a serious
problem and requires immediate medical care.
Call your doctor if:
- You have symptoms of Paget's disease-such as
bone pain or your skull getting larger (your hat size may increase)-and are
concerned that you may have the disease.
- You have Paget's disease
and have symptoms of
osteoarthritis in a joint.
- You have
symptoms of a pinched nerve in your back. The most common symptom of a pinched
nerve is leg pain and other nerve-related (neurological) symptoms, such as
tingling, weakness, or deep muscle spasms.
- You have new pain or
pain that is getting worse, especially in one area of a
bone or following an injury. Pain in one area may mean
that a bone is broken or, rarely, may be a symptom of bone cancer.
Watchful waiting
Watchful waiting is a wait-and-see approach. If you get better on
your own (or if you don't get worse), you won't need treatment. If you get
worse, you and your doctor will decide what to do next. Watchful waiting is
fine for most symptoms of Paget's disease. But if you have Paget's disease and
have symptoms that could be caused by a
complication of this disease, do not wait to get
treatment. Many experts recommend that you get treatment if you have Paget's disease in a location that could cause complications, such as in the spine, even if you are not having symptoms.
Who to see
Health professionals who can diagnose and treat Paget's disease include:
Health professionals who can diagnose
Paget's disease but usually do not treat it include:
When Paget's disease is diagnosed, you may be referred to:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Most people who have
Paget's disease have no symptoms. Most often Paget's
disease is discovered when you see your doctor for a different reason, such as
hip pain. A bone X-ray or abnormal blood test often leads to the discovery of
Paget's disease.
When your doctor or nurse suspects Paget's disease, he or she
usually can diagnose it based on your
medical history,
physical exam, bone X-rays, lab tests, and possibly a
bone scan.
Your doctor or nurse will want to be sure your symptoms are not
caused by bone cancer, noncancerous tumors, fibrous tissue within the bone, or
soft and deformed bones.
Lab tests. Lab tests alone cannot be used to diagnose Paget's disease.
Your doctor can use the results of lab tests along with results of your
physical and medical exams and bone X-rays.
- Alkaline phosphatase test. The most
important lab marker for Paget's disease is alkaline phosphatase, which is an
enzyme produced by bone. When
bone tissue grows quickly, as in Paget's disease,
large amounts of alkaline phosphatase are released into the blood. Other
body organs also make this enzyme, so your doctor will want to do more tests. The
test for alkaline phosphatase can be used to help diagnose people who have
symptoms of Paget's disease or to monitor whether the disease is
active or inactive.
- Markers of bone breakdown. Both bone and cartilage
contain
collagen, which is released when bone tissue breaks
down. Pyridinoline, deoxypyridinoline, and N-telopeptide (NTX) are fragments of
collagen that may be found in urine. High levels of these substances in the
urine may indicate Paget's disease. Tests for these markers may be done to
monitor your response to treatment, but they are not typically used to diagnose
the disease.
X-rays. Several types of X-rays may be used to confirm the
diagnosis of Paget's disease and help find out whether there are
complications from the disease. X-ray tests may
include:
- Bone scan. This is the best test for
diagnosing Paget's disease. You may have a bone scan of your entire body to
find out which bones are affected. A bone scan is also useful for finding out
whether Paget's disease is
active or inactive and may show small breaks in bones
that cannot be seen on a regular X-ray. But a number of diseases can cause
an abnormal bone scan.
- Bone X-rays. X-rays of bones affected by
Paget's disease show an uneven pattern of bone growth. The affected bones often
look deformed and thickened.
- Magnetic resonance imaging (MRI). This
test may be most useful if there are nervous system problems, such as hearing
loss, vision problems, headaches, weakness or numbness of the face, or
dizziness. Bone and nerves in the head affected by Paget's disease can be seen
on an MRI.
- Computerized axial tomography (CAT scan). This test is most often used when bones of the skull
or spine are affected by Paget's disease.
If you are diagnosed with Paget's disease, you will need regular
checkups by your doctor or nurse to watch the progress of the disease.
Monitoring may include blood and urine tests that measure the amount of
chemicals released from bone.
Early detection
Most people are not screened for Paget's disease. But if you have
a family history of this disease, you may want to talk with your doctor or
nurse about having your blood tested (alkaline phosphatase test) when you reach age 40.
Treatment Overview
Many people do not need any treatment for
Paget's disease. But the disease should be monitored
for the rest of your life because of increased risk of
complications such as inflammation of joints (arthritis), broken bones (fractures), and nerve problems. If your disease is
active, you should see your doctor every 3 months. See your doctor or nurse
every 6 to 12 months if Paget's disease is inactive.
Doctors generally recommend treatment if you have symptoms or if
you have no symptoms but are at risk of
complications. You may be at risk if:
- Your lab tests suggest that your
bone tissue is breaking down faster than
normal.
- The disease is in long bones or bones that hold up the
weight of the body (such as the
thighbones or the
spine). You may need treatment to prevent the affected
bones from becoming brittle and breaking.
- The disease affects your
skull or spine. You may need treatment for nerve problems such as
dizziness,
hearing loss, headaches, and numbness or tingling in
the body. Paget's disease in these areas may also cause deformities (such as a
bowed spine) that may make walking difficult. After bowing of bones has
occurred, it cannot be reversed with medicine.
- You are having
bone or joint surgery. If you have Paget's disease, you need treatment with
medicines to slow bone growth before surgery to reduce the risk of problems
such as bleeding after surgery.
- The disease requires you to stay in
bed for a long time. You may need treatment to prevent levels of
calcium in the blood from getting too high.
Doctors aim treatment at slowing the breakdown of bone tissue,
which may help Paget's disease to become
inactive. Treatment may also reduce pain and may help
prevent
complications.
If you have symptoms of complications from Paget's disease, such as
painful joints, you may also need treatment for these conditions.
Initial treatment
For the initial treatment of
Paget's disease, doctors usually prescribe a medicine
called a
bisphosphonate, which reduces the breakdown of bone
tissue and helps control symptoms such as bone pain. This medicine may also help prevent
complications such as
osteoarthritis or nervous system problems. If you
cannot tolerate bisphosphonate, your doctor may prescribe another medicine,
called
calcitonin.
Bisphosphonates nearly always make Paget's disease
inactive, sometimes for years or decades. In some
people, though, Paget's disease becomes
active again. So you may need to take medicine off and
on for the rest of your life.
If your bone pain does not go away while you are taking medicine
to slow the breakdown of bone tissue, you may need acetaminophen, or aspirin,
ibuprofen, or other
nonsteroidal anti-inflammatory drugs (NSAIDs).
Other treatments may include the following:
- Splints or braces to support bones and joints
can help prevent weakened bones from breaking. If your doctor prescribes a
splint or brace, be sure it fits properly. Splints or braces that do not fit
properly can cause skin irritation.
- Canes or walkers may help you
walk with less risk of falling. Ask for training in how to use these devices
properly. You can also use these reminders to help you use a cane or walker
safely:
- Physical therapy can help strengthen muscles, increase
endurance, and improve balance.
- Home health nursing may be right
for you if you are taking a medicine that must be given
intravenously. Home health nurses can also help make
your home safe to prevent you from falling.
- Acupuncture and relaxation techniques (such as
guided imagery and
biofeedback techniques) may help reduce pain in some
people.
You can help yourself at home by using these tips:
- Learn how to manage your
pain, including using a
pain diary(What is a PDF document?).
- Take precautions to avoid
falling, such as keeping floors clean and dry and
removing clutter and throw rugs.
- Use weight-bearing exercises, such
as walking, jogging, stair climbing, dancing, or lifting weights, to strengthen
bones. Be sure that you do not place stress on bones affected by Paget's
disease. Talk to your doctor or physical therapist about the best exercise
program for your condition.
- Eat a nutritious diet, and be sure you are getting adequate amounts of calcium and vitamin D. Both are needed for building healthy, strong bones. Vitamin D helps bones absorb calcium and helps muscles get stronger.
- Use a
hearing aid if you have hearing loss, or use a "white
noise" machine or background music if ringing in your ears is a problem.
Ongoing treatment
If you are using
bisphosphonate or
calcitonin medicine and
Paget's disease is still
active, you may need to continue using it.
If the disease is now
inactive, your doctor or nurse will monitor your
condition with lab tests. Recommendations for these tests vary. Your doctor may
order the tests every 3 months to once a year. Your checkups will probably
continue for life. If pain returns, or if your lab tests show active Paget's
disease, you will need to start taking medicine again. Your doctor will also
look for
complications, such as nervous system problems.
Bisphosphonates nearly always make Paget's disease inactive,
sometimes for years or decades. In some people, though, Paget's disease becomes
active again. You may need to take medicine off and on for the rest of your
life.
Consider or continue using splints or braces to support your
weakened bones. Be sure they fit properly.
Canes or walkers may help you walk with less risk of falling.
You can use these reminders on how to use a cane or walker safely:
You may need
physical therapy to help strengthen muscles, increase
endurance, and improve balance.
Acupuncture and relaxation techniques (such as
guided imagery and
biofeedback) may help reduce your pain.
You may have home health nursing if you are taking a medicine
that must be given
intravenously. Home health nurses can also help make
your home safe to prevent you from falling.
You can help yourself at home by using these tips:
- Learn how to manage your
pain, including using a
pain diary(What is a PDF document?).
- Take precautions to avoid
falling, such as keeping floors clean and dry and
removing clutter and throw rugs.
- Use weight-bearing exercises, such
as walking, jogging, stair climbing, dancing, or lifting weights, to strengthen
bones. Be sure that you do not place stress on bones affected by Paget's
disease. Talk to your doctor or physical therapist about the best exercise
program for your condition.
- Eat a nutritious diet and be sure you are getting adequate amounts of calcium and vitamin D. If you are at risk for developing
kidney stones, you should talk with your doctor or
nurse before adding these nutrients to your diet.
- Use a
hearing aid if you have hearing loss, or use a "white
noise" machine or background music if ringing in your ears is a problem.
Treatment if the condition gets worse
If
Paget's disease gets worse, you may have
complications such as
osteoarthritis. In some cases, joint replacement
surgery is needed. Sometimes doctors recommend surgery to relieve
pressure on a nerve (such as a nerve pinched by the spine) or to correct
deformed bones (such as
bowed legs). Surgical choices include total joint replacement of a
hip or
knee and
osteotomy, which may help you delay or avoid joint
replacement surgery.
Prevention
Paget's disease cannot be prevented. But you may
prevent
complications of Paget's disease, such as
osteoarthritis, by taking medicine, staying at a
healthy weight, and regularly doing gentle exercise that does not cause stress
to your
bone.
Home Treatment
Self-care-such as learning about the disease, avoiding undue stress
on your bones, and getting regular exercise-may help you if you have
Paget's disease. For example:
- Learn how to manage
pain, including using a
pain diary(What is a PDF document?).
- Take precautions to avoid
falling, such as keeping floors clean and dry and
removing clutter and throw rugs.
- Use weight-bearing exercises, such
as walking, jogging, stair climbing, dancing, or lifting weights, to strengthen
bones. Be sure that you do not place stress on bones affected by Paget's
disease. Talk to your doctor or physical therapist about the best exercise
program for your condition.
- Eat a nutritious diet and be sure you are getting adequate amounts of calcium and vitamin D. Both are needed for building healthy, strong bones. Vitamin D helps bones absorb calcium and helps muscles get stronger.
- Use a
hearing aid if you have hearing loss, or use a "white
noise" machine or background music if ringing in your ears is a problem.
Medications
Doctors can use several types of medicine to treat
Paget's disease. Although it is not possible to cure
Paget's disease with medicines, they can make the disease
inactive and may reduce complications. Medicines such
as bisphosphonate and calcitonin slow the breakdown and rebuilding of
bone tissue. You can use
over-the-counter medicines such as acetaminophen,
nonsteroidal anti-inflammatory drugs (NSAIDs), or
other pain medicines to treat bone pain.
Medication Choices
Medicines that slow the breakdown and rebuilding of bone tissue
include:
- Bisphosphonates, which are usually the
first medicines used to treat Paget's disease.
- Calcitonin, which is usually given by injection. Your
doctor probably will prescribe calcitonin if you cannot tolerate
bisphosphonates or if they have not been effective in treating your
symptoms.
What to Think About
You may need to take medicine for several weeks before symptoms
of Paget's disease improve.
Some medicines control the disease and its symptoms only while
the person is taking the medicine. Soon after the medicine is stopped, symptoms
may come back.
Your doctor may recommend medicine for Paget's disease even
though you have no symptoms. Medicines prevent the rapid breakdown of bone
tissue and may decrease the chance of
complications of Paget's disease.
An oral bisphosphonate such as alendronate (Fosamax) or
risedronate (Actonel) typically is used first. If the side effects are too much
for you, you can try
intravenous pamidronate (Aredia) or zoledronic acid
(Reclast).
Surgery
Joint replacements are the most common surgeries doctors use to
treat joint
complications from
Paget's disease such as
osteoarthritis of the hip or knee joints. If a joint
has been damaged by this disease and is causing pain, your doctor may recommend
a joint replacement (depending on the affected joint).
Osteotomy removes a wedge of bone to help reshape the
remaining bone. An osteotomy for the hip or knee is another bone surgery that
may help delay a joint replacement. But it is usually only a good choice for a
younger person.
For more information on joint replacement surgery, see:
Sometimes, doctors may do surgery to take pressure off a nerve
(such as a nerve pinched by extra bone forming in the spine) or to correct
deformed
bone (such as
bowed legs).
If you have Paget's disease and are going to have bone or joint
surgery, you may need medicine for a period of time before surgery to slow the
breakdown of bone tissue and decrease the risk of bleeding during
surgery.
Other Treatment
Other treatment for
Paget's disease includes:
- Splints and braces. These help support bones
and joints and may be used to help prevent weakened
bone from breaking. If your doctor prescribes a splint
or brace, be sure it fits properly. Splints or braces that do not fit properly
can cause skin irritation.
- Canes and walkers. These may help you
walk with less risk of falling. Ask for training in how to use these devices
properly.
- Physical therapy. This can help
strengthen muscles, increase endurance, and improve balance.
- Home
health nursing. You may have home health nursing if you are taking a medicine
that must be given through a vein (intravenous, or IV). Home health nurses can
also help make your home safe to prevent you from
falling.
- Alternative therapies.
Acupuncture and relaxation techniques (such as
guided imagery and
biofeedback) may help reduce pain in some
people.
Other Places To Get Help
Organizations
| American Academy of Orthopaedic Surgeons
(AAOS) |
| 6300 North River Road |
| Rosemont, IL 60018-4262 |
| Phone: | 1-800-346-AAOS (1-800-346-2267)
(847) 823-7186 |
| Fax: | (847) 823-8125 |
| Email: | orthoinfo@aaos.org |
| Web Address: | www.orthoinfo.aaos.org |
| |
The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise. |
|
| National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS), National Institutes of Health |
| 1 AMS Circle |
| Bethesda, MD 20892-3675 |
| Phone: | 1-877-22-NIAMS (1-877-226-4267) toll-free |
| Phone: | (301) 495-4484 |
| Fax: | (301) 718-6366 |
| TDD: | (301) 565-2966 |
| Email: | niamsinfo@mail.nih.gov |
| Web Address: | www.niams.nih.gov |
| |
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research. The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases. |
|
| NIH Osteoporosis and Related Bone Diseases—National
Resource Center |
| 2 AMS Circle |
| Bethesda, MD 20892-3676 |
| Phone: | 1-800-624-BONE (1-800-624-2663)
(202) 223-0344 |
| Fax: | (202) 293–2356 |
| TDD: | (202) 466-4315 |
| Email: | NIAMSBoneInfo@mail.nih.gov |
| Web Address: | www.niams.nih.gov/bone |
| |
The NIH Osteoporosis and Related Bone Diseases–National
Resource Center is a government resource center that helps health
professionals, patients, and the public learn about and locate current
information on metabolic bone diseases such as osteoporosis, Paget's disease,
osteogenesis imperfecta, and hyperparathyroidism. |
|
| Paget Foundation for Paget's Disease of Bone and Related
Disorders |
| 120 Wall Street |
| Suite 1602 |
| New York, NY 10005-4001 |
| Phone: | (212) 509-5335
1-800-23-PAGET (1-800-237-2438) |
| Fax: | (212) 509-8492 |
| Email: | pagetfdn@aol.com |
| Web Address: | www.paget.org |
| |
The Paget Foundation for Paget's Disease of Bone and Related
Disorders is a voluntary health agency devoted to serving people affected by
Paget's disease of bone. The foundation provides affected individuals and their
families with up-to-date information about Paget's disease and refers people
diagnosed with Paget's disease to doctors who specialize in treating this
disorder. It also assists health professionals who treat this disorder. The
foundation produces educational and support materials including brochures,
pamphlets, audiovisual aids, a newsletter titled Update,
and a guide for people affected by Paget's disease to raise public awareness of
this and related disorders. |
|
References
Citations
- Jan de Beur SM (2007). Disorders of bone and mineral
metabolism: Hypocalcemia, hypercalcemia, osteomalacia, male osteoporosis, Paget
disease of bone. In LR Barker et al., eds., Principles of Ambulatory Medicine, 7th ed., pp. 1437–1453. Philadelphia: Lippincott
Williams and Wilkins.
- Lane N (2009). Paget's disease of bone
section of Metabolic bone diseases. In GS Firestein et al., eds.,
Kelley's Textbook of Rheumatology, 8th ed., vol. 2, pp.
1593–1595. Philadelphia: Saunders Elsevier.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Anne C. Poinier, MD - Internal Medicine |
|---|
| Specialist Medical Reviewer | Jennifer Hone, MD - Endocrinology, Diabetes and Metabolism |
|---|
| Last Revised | September 1, 2011 |
|---|