American Medical Association Family Medical Guide - American Medical Association [697]
Bones weakened by Paget’s disease are more likely to fracture. In rare cases, a cancerous bone tumor develops in the abnormal bone, or the skull presses on the auditory nerve (which carries signals from the ear to the brain) at the point where the nerve passes through the skull, causing deafness. Because the heart is strained from trying to maintain the greatly increased blood flow through the diseased bones, heart failure (see page 570) can occur.
Diagnosis and Treatment
If you have symptoms of Paget’s disease, your doctor will examine you and may order X-rays, a CT scan (see page 112), and blood and urine tests to confirm the diagnosis. Nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen, or naproxen can help relieve the pain. If the pain is severe, your doctor may prescribe drugs such as mithramycin or etidronate, or give you injections of calcitonin to inhibit the breakdown of the bone.
Bone Tumors
Most bone tumors are cancers that have spread from elsewhere in the body, such as the breast or prostate gland. Tumors that result from cells that have spread from other parts of the body are called secondary tumors. Tumors that originate in bone are called primary bone tumors. Primary bone tumors are rare and usually are not cancerous. Noncancerous bone tumors include osteochondromas, osteomas, and cysts. Osteochondromas consist of bone and cartilage and tend to develop close to joints such as the knee or elbow. Osteomas are hard knobs of bone that can form on any bone but usually form on the skull. Cysts may develop in long bones, making the bones more susceptible to fracture.
Symptoms and Diagnosis
If you develop a lump on a bone (or anywhere else on your body), see your doctor right away. He or she will examine you and may order X-rays, blood tests, a CT scan (see page 112), or an MRI (see page 113) to evaluate the lump.
Treatment
Noncancerous bone tumors such as osteochondromas and osteomas do not require treatment unless they are causing symptoms. Those that cause symptoms are usually removed surgically. Bone cysts may be treated by removing the fluid from the cyst and injecting some of the person’s own bone marrow and bone tissue to rebuild the bone.
Primary bone tumors can usually be treated successfully with chemotherapy (see page 23) and by replacing the part of the bone that contains the tumor with a bone graft from another part of the body or from a human graft obtained from a bone bank. If the bone of an arm or leg is affected by a primary bone tumor, and the tumor does not initially respond to chemotherapy and radiation therapy (see page 23), the arm or leg may need to be amputated, followed by chemotherapy.
Secondary bone cancer is usually treated with chemotherapy and analgesic drugs for pain relief. Radiation therapy may also provide relief from some symptoms. If a secondary tumor has become large enough to fracture the bone, a doctor may treat the break by inserting metal plates and rods and filling any empty, dead spaces in the bone with bone cement to provide stability. A bone graft from a bone bank or from another part of the body (such as the hip) may also be used to stabilize the bone and prevent fractures. If the tumor is in the spine, a rib graft may be used. Rib grafts have an advantage over regular bone grafts because the rib can be transferred to the spine while still connected to its blood supply, which enhances healing and reduces the risk of infection.
Joint Disorders
Joints provide a range of movement to parts of the body. Because you use one or more joints every time you move, you will quickly notice if any are not working properly. A highly movable joint, such as the hip, is bound together by fibrous bands called ligaments. Inside the ligaments is a fibrous joint capsule lined on the inside by the synovial membrane, a thin membrane that continuously produces tiny