Bone pain -- the most common symptom. Bone pain can occur in any bone affected by Paget's disease. It often localizes to areas adjacent to the joints.

Headaches and hearing loss -- may occur when Paget's disease affects the skull.

Pressure on nerves -- may occur when Paget's disease affects the skull or spine.

Increased head size, bowing of limb, or curvature of spine -- may occur in advanced cases.

Hip pain -- may occur when Paget's disease affects the pelvis or thighbone.

Damage to cartilage of joints -- may lead to arthritis.

Arthritis -- Long bones in the leg may bow, distorting alignment and increasing pressure on nearby joints. In addition, Pagetic bone may enlarge, causing joint surfaces to undergo excessive wear and tear. In these cases, pain may be due to a combination of Paget's disease and osteoarthritis.

Hearing -- Loss of hearing in one or both ears may occur when Paget's disease affects the skull and the bone that surrounds the inner ear. Treating the Paget's disease may slow or stop hearing loss. Hearing aids may also help.

Heart disease -- In severe Paget's disease, the heart works harder to pump blood to affected bones. This usually does not result in heart failure except in some people who also have hardening of the arteries.

Kidney stones -- Kidney stones are somewhat more common in patients with Paget's disease.

Nervous system -- Pagetic bone can cause pressure on the brain, spinal cord, or nerves, and reduced blood flow to the brain and spinal cord.

Sarcoma -- Rarely, Paget's disease is associated with the development of a malignant tumor of bone. When there is a sudden onset or worsening of pain, sarcoma should be considered.

Teeth -- When Paget's disease affects the facial bones, the teeth may become loose. Disturbance in chewing may occur.

Vision--Rarely, when the skull is involved, the nerves to the eye may be affected, causing some loss of vision.

Osteoporosis -- Although Paget's disease and osteoporosis can occur in the same patient, they are completely different disorders. Despite their marked differences, many treatments for Paget's disease can also be used to treat osteoporosis.

Endocrinologists -- Internists who specialize in hormonal and metabolic disorders.

Rheumatologists -- Internists who specialize in joint and muscle disorders.

Specialists -- Orthopedic surgeons, neurologists, and otolaryngologists (physicians who specialize in ear, nose, and throat disorders) may be called upon to evaluate specialized symptoms.

Drug therapy
The goal of treatment is to control Paget's disease activity for as long a period of time as possible. The U.S. Food and Drug Administration (FDA) has approved the following treatments for Paget's disease.

Bisphosphonates. Five bisphosphonates are currently available. As a rule, bisphosphonate tablets should be taken with 6-8 oz of tap water on an empty stomach. None of these drugs should be used by people with severe kidney disease.

Didronel® (etidronate disodium) -- Tablet; approved regimen is 200-400 mg once daily for 6 months; the higher dose (400 mg) is more commonly used; no food, beverages, or medications for 2 hours before and after taking; course should not exceed 6 months, but repeat courses can be given after rest periods, preferably of 3-6 months duration.

Aredia® (pamidronate disodium) -- Intravenous; approved regimen 30 mg infusion over 4 hours on 3 consecutive days; more commonly used regimen 60 mg over 2-4 hours for 2 or more consecutive or non-consecutive days.

Fosamax® (alendronate sodium) -- Tablet; 40 mg once daily for 6 months; patients should wait at least 30 minutes after taking before eating any food, drinking anything other than tap water, taking any medication, or lying down (patient may sit).

Skelid® (tiludronate disodium) -- Tablet; 400 mg (two 200 mg tablets) once daily for 3 months; may be taken any time of day, as long as there is a period of 2 hours before and after resuming food, beverages, and medications.

Actonel® (risedronate sodium) -- Tablet; 30 mg once daily for 2 months; patients should wait at least 30 minutes after taking before eating any food, drinking anything other than tap water, taking any medication, or lying down (patient may sit).

Calcitonin

Miacalcin® is administered by injection; 50 to 100 units daily or 3 times per week for 6-18 months.

Fractures -- Surgery may allow fractures to heal in better position.

Severe degenerative arthritis -- If disability is severe and medication and physical therapy are no longer helpful, joint replacement of the hips and knees may be considered.

Bone deformity -- Cutting and realignment of Pagetic bone (osteotomy) may help painful weight-bearing joints, especially the knees.

Complications resulting from enlargement of the skull or spine may injure the nervous system. However, most neurologic symptoms, even those that are moderately severe, can be treated with medication and do not require neurosurgery.