Paget's

Question 1

paget’s disease

Answer 1

increased bone turnover, associated with increased numbers of osteoclasts, followed by compensatory increase in osteoblasts with resultant remodelling, bone enlargement and deformity and weakness

this new bone is thicker, weaker, abnormally shaped and predisposed to fracture.

Question 2

aetiology

Answer 2

unknown

could be due to viral/environmental/biochemical trigger in a genetically predisposed individual

Question 3

incidence

Answer 3

increases with age

rarely seen under 40

Question 4

which bones does it predominantly affect

Answer 4

long bones, pelvis, skull and lumbar spine

Question 5

presentation

Answer 5

• can be asymptomatic and an incidental X ray finding
• bone pain, deformity and deafness or compression neuropathies
• increased warmth and tenderness over bones due to increased vasculature
• enlarged head and headache
• *

Question 6

complications

Answer 6

• osteosarcoma
• fractures
• skull thickening
• high output cardiac failure due to increased blood flow through pagetic bone

Question 7

why does one present with deafness

Answer 7

• conductive due to ankyloses of the stapes
• sensorineural due to CNVIII entrapment

Question 8

biochemistry

Answer 8

normal

raised ALP (marker)

Question 9

radiographic features

Answer 9

enlarged thickened cortices and coarse, thickened trabeculae with mixed areas of lysis and sclerosis

Question 10

treatment

Answer 10

bipshophonates (eg alendronate)

joint replacement may be necessary

Question 11

what is there a high risk of

Answer 11

arthritis

especially if close to a joint