calcium and bone Flashcards
Paget's disease of bone: recall the clinical, biochemical and radiological features of Paget's disease and treatment options
describe Paget’s disease of bone
excessive bone resorption (osteoclast overactivity) followed by compensatory increase in bone formation (osteoblast), causing accelerated, localised but disorganised bone remodelling
new bone formed in Paget’s disease of bone, 2 features and 2 consequences
woven bone, so is structurally disorganised and mechanically weaker than normal adult lamellar bone; therefore causes bone frailty and bone hypertrophy and deformity as can’t withstand stress
2 causes of Paget’s disease of bone
genetic (often positive family history), viral origin (e.g. measles)
prevalence of Paget’s disease of bone
prevalent in different locations, indicating interesting cause
who is affected by Paget’s disease of bone
men and women equally, with disease not apparent <50 year old
what characterises Paget’s disease of bone
asymptomatic until bony deformity, but characterised by abnormal, large osteoclasts which are excessive in number
what regions are most commonly affected by Paget’s disease of bone
skull, thoracolumbar spine, pelvis, femur, tibia; cause enlarged bones and bowed tibia (deformed remodelling)
7 clinical features of Paget’s disease of bone
arthritis, fracture, pain,
bone deformity, increased vascularity (warmth over affected bone due to remodelling), deafness, radiculopathy
why is deafness a clinical feature of Paget’s disease of bone
cochlear involvement
why is radiculopathy a clinical feature of Paget’s disease of bone
due to nerve compression
diagnosis of Paget’s disease of bone: biochemistry
normal plasma [Ca2+], plasma [alkaline phosphatase] usually increased (from liver and bone; high as enzyme is busy in bone remodelling)
diagnosis of Paget’s disease of bone: plain x-ray
lytic lesions (early), thickened, enlarged, deformed bones (later)
diagnosis of Paget’s disease of bone: radionuclide bone scan
demonstrates extent of skeletal involvement as goes to busiest sections of bone remodelling
2 treatments for Paget’s disease of bone
bisphosphonates (reduce bony pain and disease activity by limiting osteoclasts), simple analgesia
