Paget’s disease is a chronic skeletal disorder characterised by abnormal bone remodelling, resulting in enlarged and weakened bones. It typically affects older adults and may present with no pain, deformities and complications such as fractures. However, many patients remain asymptomatic, and the disease’s complexity can lead to diagnostic and management pitfalls, impacting patient outcomes. Delayed diagnosis often occurs due to the insidious onset of symptoms, which may be misattributed to arthritis or age-related changes, leading to untreated deformities, chronic pain and inappropriate treatments. Asymptomatic cases, often detected incidentally, may be mismanaged with unnecessary interventions or lack appropriate monitoring. Clinicians may underestimate disease severity or overlook extraskeletal complications such as osteosarcoma, hearing loss or cardiovascular issues, leading to delayed or inadequate management. Effective pain control is another common challenge, as bisphosphonate therapy alone may not suffice. Optimising care for Paget’s disease requires a comprehensive approach, including early diagnosis, lifestyle modifications, tailored pharmacologic and surgical interventions and regular monitoring for disease progression and complications.