Paget’s disease due to out-of-control bone remodeling
DEAR DR. DONOHUE: Four months ago, I was diagnosed with Paget’s disease. Cortisone shots haven’t helped me. Pain medicine works, but it messes up my body. I have been active for a 65-year-old, but I am very limited now because of hip pain. I searched the Internet but found no cure for this disease. I feel helpless and depressed. Is there a treatment that I haven’t found? — M.B.
ANSWER: At the start, let me introduce you to the Paget Foundation, your best friend even though you haven’t yet made its acquaintance. The foundation will provide you and all other patients with information on the latest treatments and help you get established in a program. Call (800) 23-PAGET or visit the Internet site at www.paget.org. Medicines and other treatments can control most Paget’s disease.
From the day of birth until the day of death, bones undergo constant remodeling. One crew of bone cells, called osteoclasts, tears down bone. Its partner crew, osteoblasts, builds new bone. In Paget’s, breakdown suddenly speeds up. To compensate, rebuilding also speeds up, but the new bone is haphazardly constructed, and this leads to bone deformities. Furthermore, the new bone is of poor quality and is subject to breaking. Overgrown bone can press on adjacent nerves and cause pain, and it can invade joints and lead to arthritis. The skull, the pelvis, backbones, the hip and thigh, and the tibia (the larger lower leg bone) are the bones most often affected.
This isn’t such a rare illness. Around 2 percent of people over 55 have it. Many are without symptoms, and often the illness is discovered when an X-ray is taken for some unrelated reason. Elevation of alkaline phosphatase, found by blood test, is another clue of Paget’s disease.
People without symptoms don’t need treatment; you do. Medicines used for osteoporosis are used in Paget’s disease — drugs like Reclast, Fosamax and Actonel.
DEAR DR. DONOHUE: Is it likely that an 87-year-old lady would develop Paget’s disease? — J.P.
ANSWER: Paget’s bone disease strikes mostly older people. A woman of 87 could come down with it.
Or the woman could have had the illness much longer. She might have had no symptoms until now. Many Paget’s disease patients are without symptoms, some for life. Others develop symptoms when the Paget’s bone presses on nerves or joints. Or the breaking of a bone can reveal Paget’s disease. Paget’s bone is fragile and easily broken.
DEAR DR. DONOHUE: My husband died only minutes after we had sex. Did the sex cause a heart attack? If so, why? He was 69, and he did have a cardiac history. — N.A.
ANSWER: You have my sincerest sympathy on the untimely death of your husband and the circumstances of his death.
Sexual activity is not strenuous physical exertion. It’s the equivalent of walking a mile in half an hour, not tremendously taxing exercise. Furthermore, it’s not dangerous activity for most people with heart disease. Even after a heart attack, sex is permitted in three to four weeks. Anger is much more likely to provoke a heart attack than is sex.
Having said this, I have to admit that it’s hard not to relate your husband’s death to sex since the two were so closely related in time. A heart attack or heart-rhythm disturbance is the most probable explanation. Your husband’s heart arteries must have been quite clogged with cholesterol and fat. It’s not outlandish to speculate that he would have had a heart attack in doing any minor physical work. Apparently, he was one of those people who do not have warning symptoms that heart arteries are dangerously narrowed and that a heart attack is imminent.
Without those warnings, nothing could have been done to save your husband’s life. This is a tragic event that appears not to have been avoidable.
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.