Here's my original post of the thread:
[ From: Dr. Jai Maharaj
[ Subject: WEAK BONE STRIKES
Weak bone strikes
By Priyanka Banyal
The Pioneer
Monday, May 13, 2002
Paget's Disease of Bone (PDB) is a focal disorder in bone
metabolism that enlarges affected bones and deforms them.
The process can be painful as well. Though the causes of
this disease are unknown, investigators have ascribed it
to a virus. Genes could also be responsible.
Also known as osteitis deformans, PDB is a breakdown in
the body's ability to form bones. The bones become
thicker, weaker, and deformed in cycles, as it subsides
and flares up, getting progressively worse.
Usually, the body balances the number of bone cells it
breaks down with the number of new bone cells it forms.
In PDB, this process is thrown off-balance. "This disease
reflects a slow progression of bony overgrowth, it
usually becomes apparent in middle age and may cause no
distress until later in life (it is uncommon before age
40) when the pagetic bone presses on nerves and
interferes with the function of joints," says Dr Yash
Nigam, a private practitioner in Gulmohar Park.
"Complications can include arthritis, back pain, injury
to nerves, bowing of limbs, fractures and rarely, even
bone cancer of the skull, spine, pelvis, femur, tibia,
humerus, or scapula," he adds. "PDB can be diagnosed in
patients through radiology, radionuclide bone scanning,
biochemical testing of bone resorption parameters or
biochemical testing of bone formation parameters."
When tested through roentgenography or radiography, PDB
displays three distinctive stages. In the earliest stage,
a lesion may be observed in the skull or a long bone. In
the second stage, x-rays reveal both osteolytic and
sclerotic changes and finally, the sclerotic lesion
dominates the bone, accompanied by an increase in the
dimensions of the bone itself, explains Nigam.
Adds Dr Sharma of South Point Hospital, "There are no
symptoms of this disease. The only diagnosis possible is
a chance X-ray."
Laboratory studies like a simple blood test will
invariably show an increased level of alkaline
phosphatase, a byproduct of bone formation. Calcium
levels within the body are usually normal. Enlarged
spinal bones may press on sensory nerves, causing pain
and sometimes cutting off all feeling in the legs. The
facial bones may also become distorted-a condition called
leontiasis, because the face acquires the look of a lion.
Leontiasis can lead to damage in the inner ear, noises in
the ear (tinnitus), dizziness and headaches. A sufferer
can also turn blind or deaf due from the pressure of the
skull on the brain. Other signs include slurred speech,
hearing loss, visual disturbances and swallowing
problems.
Though early treatment is now available for this disease,
it is hoped -but yet unproven-that such therapy will
prevent future complications.
"PDB is a metabolic condition that makes bone cells
weaker and gives them more blood vessels than is normal,
Irregular bone structure makes them prone to fracture
even after minor injuries," says Gaur, an orthopaedic in
Patparganj.
"Paget's disease afflicts up to three per cent of the
population, with twice as many men usually affected than
women," says Gaur.
Bone pain usually results from rheumatologic and
neurologic complications of the disease rather than from
the pagetic lesions themselves. When bone pain does occur
among patients, its onset is frequently late in the
disease process and is usually unrelated to physical
activity. "It generally occurs in weight- bearing bones
like the skull, pelvis and spine," explains Dr Sharma.
According to Dr Rajiv, an orthopaedic, "The initial
abnormality in this disease is a dramatic increase in the
rate of bone resorption at areas of heightened bone
remodelling."
"Skeletal deformities that occur are most often noted in
the lower extremities and the skull. Long bones tend to
exhibit bowing, while the skull can become enlarged. An
enlarged skull can lead to headaches or hearing loss when
the disease affects the temporal bone", says Gaur.
PDB is difficult to treat because of the progressive
destruction of bone and setting-in of deformities. Says
Dr Sharma, "The disease is not curable. All doctors can
prescribe are drugs like Calcitonin or Mithramycin to
reduce bone turnover but the results a re not very
satisfactory. Bed rest is essential, for it may also
result in secondary arthritis."
The most devastating complication arising from PDB is
Osteogenic Sarcoma - bone cancer. This occurs in less
than one percent of patients, but at a significantly
higher rate than in non-affected individuals. In addition
because of the high rate of bone turnover, the demands on
the heart also increase, and patients with Paget's tend
to have more heart problems.
The cause of Paget's Disease is not entirely known, but
it is thought to be caused in part from a childhood
virus. "Family history may be one precipitating factor,"
says Dr. Sharma.
Paget's Disease is more common in certain geographical
locations, specifically England, Western Europe, and the
United States. It is very uncommon in Scandinavia, China,
and India. It is most commonly diagnosed in the sixth
decade and increases with age. It is very uncommon in
individuals under 40 years of age. In most cases, Paget's
is a mild disease that does not cause any problems or
complications. In fact, about 80 per cent of individuals
are diagnosed following an x-ray performed for an
unrelated reason.
This disease is the second most common bone disease in
the world and the prevalence in the population ranges
from 1.5 per cent to eight per cent, depending on the
person's age and the area of the world where he or she
lives. Paget's disease affects 3 per cent of people over
the age of 40 and 10 per cent over the age of 80 years
(With input from Neharika Mathur)
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In article <3EFCC0F3.F229D0C4@Grandecom.net>,
Ob-1 <SOS@Grandecom.net> posted:
