DEAR DR. DONOHUE: I have just been diagnosed with Paget’s disease of bones and osteoarthritis. It started out as back pain that got worse. My doctor sent me to a specialist, who did a bone scan and X-rays and came up with the diagnosis. I am on Fosamax. Do you have any information on Paget’s? I have developed hearing loss and have to wear hearing aids. – G.H.

ANSWER: Everyone has heard of osteoporosis. Few have heard of Paget’s bone disease, yet it is the second most common adult bone disease, following osteoporosis.

Every day of our lives, bones undergo constant remodeling. One kind of cell chips away bones. Another kind reconstructs them. In Paget’s, the demolition cells outpace the bone-building cells. The bone-building cells then go into overdrive and hastily construct new bones of poor quality and lay them down haphazardly and in misshapen patterns. Such bones break easily. The grotesque bone shapes cause pain and can press on adjacent structures like nerves, producing even greater pain. Compression of the hearing nerves can bring on deafness.

Not every Paget patient develops symptoms. In some, the process is limited to a small area of only one bone. These people are diagnosed when X-rays or bone scans are ordered for completely different reasons.

A new drug – actually a member of an older family of drugs, the bisphosphonates – is approved for Paget’s disease. It’s Reclast and is given in a 15-minute infusion every six months.

Your arthritis might be secondary to Paget’s disease or it might be an entirely separate condition. If the latter proves to be true, then you have to use osteoarthritis drugs – the nonsteroidal anti-inflammatory medicines like Aleve or Advil being commonly recommended.

Contact The Paget Foundation at 800-23-PAGET or at its Web site, www.paget.org. The foundation provides people with up-to-date information and gives them useful tips in coping with this illness.

DEAR DR. DONOHUE: I have osteoarthritis of the hips. I am 64 and take diclofenac for it. My orthopedic doctor says I eventually will need hip replacement. The pain is bad at all times, and I work full shifts for police security. I want to continue to work. Is the infection rate for hip surgery high? Should I get this taken care of soon? I worry about the side effects of diclofenac. – J.D.

ANSWER: Diclofenac (Voltaren) is a nonsteroidal anti-inflammatory drug – NSAID – drugs frequently prescribed for arthritis since they quiet joint inflammation and have pain-relieving properties. All drugs have side effects. NSAIDs slightly heighten the risk of heart attack and stroke. They can cause ulcers and bleeding. They might raise blood pressure or make it more difficult to control. Millions of prescriptions have been written for these drugs, but the incidence of serious side effects from them has been relatively low.

As for infection following hip replacement, it happens, but it does so infrequently. The skin is our protection against infections. Breaching it with a scalpel makes us more susceptible to germ invasion, but that holds for every kind of surgery.

You should have your hip replaced when you determine you need it. You make the determination based on the amount of pain you’re having and on the degree of impairment your hips impose upon you.

DEAR DR. DONOHUE: Through the years, I’ve been wondering about this thing called a veil. I was born with it. They say it is a sign of luck. What can you tell me about it? I am 76. – F.P.

DEAR DR. DONOHUE: What does it mean when a newborn infant emerges from the birth canal with a caul? Does a child like this need extra loving care? – L.C.

ANSWER: In the uterus, the developing fetus is covered with a membrane called the amnion. Sometimes at birth, a piece of amnion sticks to the baby’s head and face. That’s the veil or caul. The doctor can remove it without trouble. A sign of luck? I don’t know. A sign for extra loving care? All babies, caul or not, need that.

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