Paget's Flashcards
What is Paget’s disease of bone?
Excessive bone remodelling at one (monostotic) or more (polyostotic) sites resulting in bone that is structurally disorganised
What is the aetiology of Paget’s disease?
UNKNOWN
Genetic factors + viral infection may play a role
Describe the pathogenesis of Paget’s disease
Excessive bone resorption by abnormally large osteoclasts is followed by increased bone formation by osteoblasts in a disorganised fashion
Results in an abnormal pattern of lamellar bone
Marrow spaces are filled by an excess of fibrous tissue with a marked increase in blood vessels
Describe the epidemiology of Paget’s disease
Common in ELDERLY
3% of > 50 yrs
10% of > 80 yrs
M = F
List symptoms of Paget’s disease
Headaches
Deafness
Vision changes
Bone pain
List signs of Paget’s disease
Bitemporal skull enlargement + frontal bossing
Spinal kyphosis
Anterolateral bowing of femur, tibia or forearm
Skin over affected bone may be warm + erythetamous (due to increased vascularity)
Sensorineural deafness (compression of vestibulocochlear nerve)
What bloods should be taken in Paget’s disease?
High ALP
Ca2+, phosphate + PTH = NORMAL
What may be seen on a bone radiograph in Paget’s disease?
Enlarged, deformed bones
Lytic + sclerotic appearance
Lack of distinction between cortex + medulla
Thickened cortical bone
Why perform a bone scan in Paget’s disease?
Assesses extent of skeletal involvement
Pagetic bone lesions are seen as areas with markedly increased uptake
Why use resorption markers in Paget’s disease? What is measured?
Monitors disease activity
Urinary hydroxyproline
How may Paget’s disease present?
Asymptomatic
Insidious onset pain, aggravated by weight bearing + movement
What are the 3 phases of Paget’s disease?
- Lytic
- Mixed lytic + blastic
- Sclerotic
What changes are seen on a skull radiograph in Paget’s disease?
Osteoporosis circumscripta “Cotton wool appearance”
Enlargement of frontal + occipital areas
