MSK and Rheum - Paget's Disease of Bone

Question 1

Paget’s Disease of Bone - what is it?

Answer 1

Disorder of excessive bone remodelling, so excessive bone resorption (osteoclastic) followed by increased bone growth (osteoblastic activity), leading to haphazard bone growth, and that results in weak and misshapen bone

This misshapen bone can then impinge and compress on other parts of the body like nerves

Question 2

Paget’s Disease of Bone - causes?

Answer 2

Cause is unclear, but it is triggered by infections

Question 3

Paget’s Disease of Bone - what bones does it commonly affect?

Answer 3

Skull

Lumbar vertabrae

Pelvis

Femur

Question 4

Paget’s Disease of Bone - clinical features?

Answer 4

Only 5% are symptomatic

Bone pain

Question 5

Paget’s Disease of Bone - investigations?

Answer 5

Bloods:
ALP IS RAISED
Calcium and phosphate are normal

XRAY:
Skull - ill-defined sclerotic and lucent areas

Question 6

Paget’s Disease of Bone - management?

Answer 6

Bisphosphonates:

1. Oral risedronate
2. IV zoledronate

Question 7

Paget’s Disease of Bone - complications?

Answer 7

Deafness, cranial nerve entrapment

Bone sarcoma - Osteosarcoma

Skull thickening