Paget’s bone disease can lead to broken bones

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DEAR DR. DONOHUE: My husband and I would be most grateful if you would say something about Paget’s bone disease. He has it. It was discovered on an X-ray taken two weeks ago. He hasn’t gotten any treatment yet. What will that be? – P.C.

ANSWER: Paget’s bone disease is a relatively common bone disorder of older people. Bones are not inert structures. From the first day of life to the last, bones are constantly being remodeled. Special bone cells nibble away at old bones while equally special cells set in to build new bones. In Paget’s disease, the breakdown process speeds up. To compensate, bone-building cells hastily erect new bone, but the resulting bone is not the quality of normal bone. It is weak and deformed. Such bone is subject to breaking. The bone deformity can press on adjacent structures, like nerves or joints, and create big problems. Bones most often involved in this process are the pelvis, spine, skull, femur (upper leg bone) and tibia (lower leg bone).

Often, Paget’s is discovered accidentally. An X-ray is taken for some unrelated reason, and the affected bone is spotted. Or a blood test, an alkaline phosphatase, is ordered, and the reading is high. Alkaline phosphatase is a bone enzyme, and high blood levels indicate that great activity is taking place in the bones.

When Paget’s disease is limited to a small section of bone, it frequently produces no symptoms. If that proves to be the case for your husband, no treatment will be needed

For more widespread bone involvement, Fosamax, Actonel, Aredia and Skelid can slow the bone destruction of Paget’s disease. A new drug, Zometa, is about to be introduced to the market. Those five drugs are members of one drug family, the bisphosphonates. Another Paget’s drug, unrelated to those five, is Miacalcin.

Both your husband and you should contact the Paget’s Foundation at 1-800- 237-2438. You’d be hard pressed to find a foundation that provides so much information and help to patients as this one does.

DEAR DR. DONOHUE: My son, now 5 months old, was born with an undescended testicle. The pediatrician discovered it shortly after he was born. He’s developing normally in all respects, but the doctor says that he will have to have surgery if the testicle doesn’t descend on its own. What’s the rush? Can an operation wait until he’s older? – B.L.

ANSWER: During most of fetal life, the testicles are in the abdominal cavity. Before birth, they make their way down to the scrotum.

One or both testicles can stall out anywhere on the path to their final destination. Such a testicle is an undescended testicle.

It’s a common problem. At birth, close to 5 percent of boys have an undescended testicle. The percentage is higher in premature boys. By 6 months of age, most undescended testicles have made their way into the scrotum.

The testicles have to be in the scrotum to produce sperm. They need a temperature slightly lower than body temperature. Furthermore, the higher body temperature can cause cancerous changes in them. And the changes take place early on. In order to prevent infertility and testicular cancer, an undescended testicle has to be repositioned surgically into the scrotum between the ages of 9 months and 15 months.

Your pediatrician is simply following accepted guidelines.

DEAR DR. DONOHUE: I believe I have lost some height. I used to be 5 feet 5 inches tall. I am 73, and measured myself to see if I am shorter than I was; I am. I am 5 feet 4 inches, and I’m cheating to make it to that height. Does this happen with age? – L.L.

ANSWER: Everyone loses height with aging. Most people lose at least 1 inch.

Some of the loss has to do with dehydration of spinal disks, the shock absorbers placed between adjacent backbones.

A larger amount comes from shrinkage of the backbones themselves. With osteoporosis, body weight squashes backbones. Sometimes it causes them to collapse – a compression fracture. When that happens, the loss of height can be quite startling.

DEAR DR. DONOHUE: I had a CT scan of my sinuses. Nothing was found in them, but the scan shows I have a meningioma. My doctor referred me to a neurosurgeon. He reviewed the scans and did a very thorough examination. He says nothing needs to be done for the tumor now. I am relieved, of course, but I am uneasy about leaving a brain tumor go untreated. What would you advise me to do? – A.H.

ANSWER: I advise you to follow the neurosurgeon’s advice.

Meningiomas are not brain tumors. They arise from the meninges, the brain’s covering tissues. They are benign tumors, most often. “Benign” means they don’t spread to other parts of the body.

They can, however, produce symptoms if they grow large and put pressure on the brain. A large meningioma, for instance, might cause a person to have headaches.

Most meningiomas grow very slowly, about 0.1 inch (0.254 cm) a year.

If they aren’t causing symptoms and if they put no pressure on the brain, then the decision to watch them is safe and for the best. My mother had a meningioma, and she never had a single symptom throughout her long life.

DEAR DR. DONOHUE: Can you catch psoriasis? My fiance has it, and I wonder if I will get it? – B.B.

ANSWER: Psoriasis is not catchy. Put the idea out of your mind.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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