Paget’s Disease Of Bone
James Paget, 1877
Paget’s disease of bone
general information about disease
Etiology:
genetic causes
viral causes
Effects of disease
skeletal
spinal
neurological
Diagnosis of Disease
radiographic examinations
laboratory tests
Treatment and Prognosis for patient
bisphosphonates
calcitonin
disease can be treated but not cured.
Paget’s Disease of Bone
In 1877, Sir James Paget first described a disease that he had identified in a small number of patients who had been described as “having overly large heads and enlarged or deformed extremities with a higher likelihood of fracture.” (Chaffins) While Paget believed that this disease was a relatively new one, archaeological studies have since found evidence of it in skeletons from the first century A.D., as well as from the Medieval period. “Paget’s disease of bone (PDB), also called osteitis deformans, “is a nonmalignant disease of bone that causes accelerated and abnormal bone remodeling.” (Chaffins) In other words, as a bone in the human body naturally decays, old bone would normally be recycled into the components to construct new bone tissue. But with Paget’s disease of bone, the rate of bone rebuilding and that of the bone decaying is out of sync, resulting in “production of bone that is denser than normal, but which is structurally disorganized and mechanically weak.” (Daroszewska, 270) In humans, the only other major bone disorder that is more common than Paget disease of the bone is osteoporosis. Paget’s disease is typically a localized condition, meaning it is usually limited, but not exclusively, to a single bone located in the axial skeletal region. And while the exact cause of Paget’s disease of bone is not known, it is likely that genetic factors are involved. There is also new evidence that certain viral agents associated with the measles virus, the canine distemper virus, and the respiratory syncytial virus may also be involved in the development of Paget’s disease of bone. In the United States, approximately 1% of the population may get this disease, but those susceptible can usually trace their lineage to Western Europe. The disorder is rare in lieages from China, India, Japan, and other parts of Asia, as well as, strangely, Scandinavia.
It has been recognized for more than 50 years that Paget’s disease of bone has a genetic component to it, and between 15% and 40% of patients have family history of the disease. While “epidemiological studies indicate that the risk for developing PDB in relatives of patients with the disease is increased between 7 and 10 times.” (Daroszewska, 271) It is believe that Paget’s disease of the bone demonstrates Autosomal Dominant Inheritance as well as familial clustering of genes associated with the disease. And patients who have family members with Paget’s disease generally will develop more pronounced effects of the disease at an earlier age. There has also been a familial link to a predisposition for the disease to attack a particular bone in the body, but this is not a widely spread feature of the disease. The evidence for genetic factors in the development of Paget’s disease can also be found in the fact that certain ethnic groups are more likely to develop the disease, even after leaving their homeland and emigrating to other parts of the world. The fact that the disease continues to be prevalent in certain ethnic groups, despite the fact that they have emigrated, increases the likelihood that the disease is caused by genetic factors within the group rather than environmental factors within the environment where they reside. Recent molecular genetic research has also identified a number of genes that are likely involved in the development and mechanisms of Paget’s disease. (Daroszewska, 272)
In most patients, pain is often the symptom that causes a person to seek treatment, or at least discovery of what is causing the pain. In the case of Paget’s disease of bone, the individual consequences of the disease will depend upon which bone is the sight of the infection, how long the disease has been present, and the number of bones affected. When Paget’s disease affects the skull, the affects can be a deformity of the skull, hearing loss, and other neurological consequences due to the bone interacting with the brain tissue. In the spine, Paget’s disease can lead to “nerve root compression, spinal stenosis, the cauda equina syndrome and fractures.” (Seton) Complications of Paget’s disease can be high output failure, renal stones or hypercalcaemia, and sometimes, when a patient is bedridden, profound shifts in calcium. Rarely, a cancer called osteosarcoma may arise in older people affected by Paget’s, these cancers form a major proportion of osteosarcoma in senior citizens. (Seton)
Studies have determined that since the pattern of this disease follows the same pattern as degenerative joint disease in the elderly, Paget’s disease is normally located in the axial skeleton, skull, and long bones of the legs (tibia and femur), as well as in the lumbar and cervical regions, hips, and knees. “In patients with skull involvement, hearing loss is the most common complication, but tinnitus might also occur. Dental complications in patients with maxillary or mandibular disease include malocclusion and loss of teeth.” (Singer 484) But the most common site of Paget’s disease is the spine, with the sacrum and lumbar region being affected most often. When the disease affects the lower extremities, fractures are the most common symptom of the disease and generally are across the bone. Paget’s disease has also been known to have effects on the cardiovascular system and metabolism. (Singer 484)
Paget’s disease can often be diagnosed through radiological technology, such as X-rays, CT scans, and MRI’s; and there are a number of signs of Paget’s disease among which are “osteoporosis circumscripta, lesions, osteosclerosis, increased thickness and circumference of bone, compression from softening of bone, separation and displacement of teeth, picture-frame vertebrae, enlarged cranium with increase in the marrow space, and intense uptake of radioactive tracers by involved bone.” (Flowers, S34) In the early stages of the disease, a condition called osteolysis can usually be detected on radiographs as lesions on the bones. As the disease progresses, radiographs can show an increase in the density of the bone, abnormal structures, thickening of the bones, as well as discrete fractures. (Chaffins) In the sclerotic phase of the disease, bones can be uniformly thickened without natural striations; giving the bones an “ivory” appearance. But since radiological markers can often be confused with other diseases, laboratory testing should also be undertaken for a confident diagnosis. “Total serum alkaline phosphatase and urinary pyridinoline are 2 of the most important lab tests for diagnosis of Paget disease.”(Chaffins) Studies have demonstrated that there is a direct association between progression of the disease and the level of certain biochemical markers.
While many patients do not require any treatment for Paget’s disease of bone, others do, and therapy consists of chemical agents which are used to suppress the orthoclase activity. These agents are referred to as bisphosphonates and have been proven to be effective in the treatment of patients with Paget’s disease. The U.S. Food and Drug Administration currently has approved 5 bisphosphonates, each with an increased level of potency and effectiveness. “In order of increasing potency, these are etidronate disodium, tiludronate disodium, pamidronate disodium, alendronate sodium and risedronate sodium.” (Chaffins) Besides the use of these agents, Calcitonin is the only other known treatment for Paget’s disease of bone, and is effective in reducing bone turnover. And while there is some evidence that chemical agents can provide some relief for the pain and oseolytic disease often associated with Paget’s disease, “there is no convincing evidence that treatment is effective at preventing chronic complications, such as deafness, deformity and secondary arthritis” (Cundy) However, since chronic complications tend to develop over years, or decades, recent treatments may yet prove themselves effective. There is also the problem of whether or not patients using bisphosphonates can develop a resistance to the drugs. Resistance can be defined as the shortened time to relapse after receiving repeated same-dose treatments, and some patients have demonstrated the ability to develop a resistance to the drugs. Changing the drug, and increasing potency is a viable means of dealing with the problem of resistance, but as the disease progresses toward its final stages, the level of drug needed for treatment can increase exponentially.
How effective treatment can be usually depends upon the individual, their genetic predisposition, but also their lifestyle; including diet and exercise. Since Paget’s disease of bone weakens the bones and often leads to fractures, patients with this disease need to take care to prevent falls. One of the reasons there is a certain level of mortality associated with this disease is the effects on a person’s health due to inactivity caused by fractures. In older patients especially, inactivity can lead to other, more debilitating problems; and therefore patients suffering from Paget’s disease should take care to “fall-proof” their home. This could include using a walker or cane, removing slippery floor coverings, install handrails, or using nonskid mats in showers and baths. By removing the possibility of falling and suffering a major fracture, patients can increase their likelihood of surviving longer with this disease. Diet is also an important part of health and is especially important if a patient is being treated with pharmaceutical agents such as bisphosphonates. Increasing a patient’s intake of Calcium and Vitamin D is another extremely important factor for the uptake of calcium which strengthens bones. And finally, maintaining mobility and bone strength is essential for a patient with Paget’s disease, and nothing can do that better than regular exercise. While some activities could be harmful, consulting a doctor and fitness specialist can help in developing a program of exercise that is optimal.
Paget’s disease of bone is a disease that interferes with the normal biological processes of bone tissue, causing a number of adverse effects which could include things from abnormal bone growth to lesions and fractures. While there are some treatments for Paget’s, these treatments deal mostly with the pain associated with the disease, as well as chemical agents which help regulate bone growth. Despite these treatments, there is really no successful way to deal with the chronic complications associated with the disease. While a patient’s pain can be eased, and the symptoms of the disease delayed, there simply is no cure currently available for patients with Paget’s disease of bone.
Works Cited
Chaffins, Julie A. “Paget disease of bone.” Radiologic Technology 79.1 (2007): 27+.
Academic OneFile. Web. 19 Feb. 2012.
Cundy, Tim, and Brya Matthews. “Paget’s disease of bone.” Expert Review of Endocrinology & Metabolism 4.6 (2009): 651+. Academic OneFile. Web. 21 Feb.
2012.
Daroszewska, Anna, and Stuart H. Ralston. “Mechanisms of Disease: genetics of Paget’s disease of bone and related disorders.” Nature Clinical Practice Rheumatology
2.5 (2006): 270+. Academic OneFile. Web. 19 Feb. 2012.
Flowers, W. Mel, Jr. “Radiological signs of Paget’s disease.” Southern Medical Journal
(Oct. 2004): p. S34. Academic OneFile. Web. 19 Feb. 2012.
Leach, Robin J. And Frederick R. Singer “Do all Paget disease risk genes incriminate the osteoclast?” Nature Reviews Rheumatology. 6.9 (Sept. 2010): p502. Academic
OneFile. Web. 19 Feb. 2012.
Seton, Margaret. “Diagnosis, complications and treatment of Paget’s disease of bone.”
Aging Health 5.4 (2009): 497+. Academic OneFile. Web. 20 Feb. 2012.
Singer, Frederick R. “Paget disease: when to treat and when not to treat.”
Nature Reviews Rheumatology. 5.9 (Sept. 2009): p483. Academic OneFile. Web. 20 Feb. 2012.
Get Professional Assignment Help Cheaply
Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?
Whichever your reason is, it is valid! You can get professional academic help from our service at affordable rates. We have a team of professional academic writers who can handle all your assignments.
Why Choose Our Academic Writing Service?
- Plagiarism free papers
- Timely delivery
- Any deadline
- Skilled, Experienced Native English Writers
- Subject-relevant academic writer
- Adherence to paper instructions
- Ability to tackle bulk assignments
- Reasonable prices
- 24/7 Customer Support
- Get superb grades consistently
Online Academic Help With Different Subjects
Literature
Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.
Finance
Do you struggle with finance? No need to torture yourself if finance is not your cup of tea. You can order your finance paper from our academic writing service and get 100% original work from competent finance experts.
Computer science
Computer science is a tough subject. Fortunately, our computer science experts are up to the match. No need to stress and have sleepless nights. Our academic writers will tackle all your computer science assignments and deliver them on time. Let us handle all your python, java, ruby, JavaScript, php , C+ assignments!
Psychology
While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.
Engineering
Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.
Nursing
In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.
Sociology
Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.
Business
We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!
Statistics
We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.
Law
Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.
What discipline/subjects do you deal in?
We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.
Are your writers competent enough to handle my paper?
Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.
What if I don’t like the paper?
There is a very low likelihood that you won’t like the paper.
Reasons being:
- When assigning your order, we match the paper’s discipline with the writer’s field/specialization. Since all our writers are graduates, we match the paper’s subject with the field the writer studied. For instance, if it’s a nursing paper, only a nursing graduate and writer will handle it. Furthermore, all our writers have academic writing experience and top-notch research skills.
- We have a quality assurance that reviews the paper before it gets to you. As such, we ensure that you get a paper that meets the required standard and will most definitely make the grade.
In the event that you don’t like your paper:
- The writer will revise the paper up to your pleasing. You have unlimited revisions. You simply need to highlight what specifically you don’t like about the paper, and the writer will make the amendments. The paper will be revised until you are satisfied. Revisions are free of charge
- We will have a different writer write the paper from scratch.
- Last resort, if the above does not work, we will refund your money.
Will the professor find out I didn’t write the paper myself?
Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.
What if the paper is plagiarized?
We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.
When will I get my paper?
You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.
Will anyone find out that I used your services?
We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.
How our Assignment Help Service Works
1. Place an order
You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.
2. Pay for the order
Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.
3. Track the progress
You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.
4. Download the paper
The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.
PLACE THIS ORDER OR A SIMILAR ORDER WITH US TODAY AND GET A PERFECT SCORE!!!
