Paget’s disease

Bone disorder in which the normal process of bone formation and resorption is accelerated, with the formation process dominating. Bones form freakishly, however. The disease occurs principally in older people; about 3 per cent of people over 50 are sufferers, but in very different ways. The cause is unknown; the disorder sometimes occurs in several members of the same family. Characteristic symptoms are thickening of the bones of the skull, increasing its circumference, and deformity of the lower and upper legs. The patient’s hat may become too small, and his trousers too long. Thickening of the skull can cause headache, and possibly also deafness through narrowing of the ear canal. The leg deformities often cause the patient to waddle. Usually there is little real discomfort. The disease is uncurable, but sometimes This can be deliberate, as in women using the contraceptive pill; a normal physiological phenomenon, as in pregnancy and often in breast feeding; or an illness or symptom of a disorder. There are various more or less serious causes of anovulation, and it can occur occasionally or persist for years. Ovulation can be missed for several consecutive months through stress or fatigue, in cases of rapid loss of weight or an underweight condition (such as anorexia nervosa), or in women who take part in endurance sports such as marathon running. In these cases anovulation is probably a natural protection against having a pregnancy in unfavourable conditions. Various disorders of the ovaries prevent ovulation, such as ovarian cysts, diseases or tumours of the thyroid or it may be the result of high levels of corticosteroid hormones. Gynaecological and endocrinological tests over a long period may be necessary to establish the cause; treatment and the possibility of treatment depend on the cause. Its advance can be prevented by medica tion with calcitonin, a thyroid hormone which reduces bone resorption while at the same time inhibiting bone formation (which is normally a reaction to the resorption). Further treatment is by physiotherapy and painkillers, if needed.