Home » Accordion » POTENTIAL COMPLICATIONS

The overall frequency with which complications occur in PDB is unknown but when they occur, surgical treatment is often required. Medical treatment with bisphosphonates is seldom effective at treating complications of Paget’s disease when they are established. 

Bone Deformity
Paget’s disease can cause bone to become enlarged and misshapen. Long-standing disease may cause the weight-bearing bones of the leg to bow.
Osteoarthritis
Paget’s disease can predispose to the development of osteoarthritis at adjacent joints. Joint replacement is common in those with Paget’s disease (Figure 2). The changes of Paget’s disease usually affect only one side of a joint and are not present in both bones that make up the joint. 
Fracture
There is an increased risk of fracture, particularly in the weight-bearing bones of the legs. Fractures may initially be incomplete, (stress fractures or fissure fractures), which are at high risk of complete fracture. Fissure fractures predominantly, but not exclusively, affect weight-bearing bones, such as the thigh bone (femur).
Hearing Loss
If the skull is involved, hearing loss can occur. 
Nerve Entrapment
Enlarged bones may cause nerve compression. Complications can therefore include basilar invagination of the skull, obstructive hydrocephalus, spinal canal stenosis, and paraplegia. It has been suggested that, in some cases, paraplegia may be due to a vascular “steal” phenomenon, rather than direct compression of the spinal cord. 
Excessive Blood Loss During Surgery
Owing to the increased blood flow to areas of active PDB, were the bone to fracture or surgery be undertaken, active disease would have the potential to result in excessive blood loss in patients undergoing surgery.
Cardiac Failure
In severe cases, high-output cardiac failure, due to increased bone blood flow, has been reported but is extremely rare, especially as Paget’s disease is decreasing in severity.
Paget’s Associated Osteosarcoma 
Osteosarcoma associated with Paget’s disease is a rare primary bone cancer. It should be suspected in any patient with Paget’s disease, where there is a sudden increase in bone pain, or there is enlargement of the affected bone. Patients suspected to have osteosarcoma should undergo urgent imaging with a CT scan or MRI and be referred for a surgical opinion.

Osteosarcoma associated with Paget’s disease is a rare primary bone cancer. It should be suspected in any patient with Paget’s disease, where there is a sudden increase in bone pain, or there is enlargement of the affected bone. Patients suspected to have osteosarcoma should undergo urgent imaging with a CT scan or MRI and be referred for a surgical opinion.

Page to appear on: 

Receive the paget’s magazine

By becoming a member

Become a Friend of the Paget's Association

If you are not a member of the Association, but would like to stay up to date with our news and events via our mailing list, please sign up here to become a Friend of the Association. Please note, if you are a member, there's no need to sign up here as you already receive our updates and much more!

Your Details