Paget's and osteomalacia

Question 1

What is Paget’s disease?

Answer 1

Increased bone turnover associated with increased numbers of osteoblasts and osteoclasts with resultant remodelling, enlargement, deformity, weakness

Question 2

Risk factors of Paget’s?

Answer 2

Anglo Saxon
Temperate climates
Over 40s

Question 3

Clinical features of Paget’s?

Answer 3

Deep, boring pain

Bony deformity and enlargement
Typically pelvis, L spine, skull, femur, tibia (bowing)

Question 4

Complications of Paget’s?

Answer 4

Deafness due to compression of nerve in bony meatus

CCF due high output due to extra bone vasculature

Osteosarcoma

Question 5

Investigations of Paget’s?

Answer 5

ALP markedly raised

XR: enlarged bones, cortical thickening, sclerosis, osteolysis, deformity

Question 6

Management of Paget’s?

Answer 6

Analgesia

Alendronate can help with pain and deformity

Question 7

What is osteomalacia?

Answer 7

Normal amount of bone but mineral content is low

Rickets = this process before fusion of epiphyses

Osteomalacia = this process after fusion of epiphyses

Question 8

Clinical features of Rickets?

Answer 8

Growth retardation
Bow-legs
Hypotonia
Apathy
Deformities

Question 9

Clinical features of osteomalacia?

Answer 9

Bone pain
Tenderness
Fractures
Proximal myopathy

Question 10

Investigations of osteomalacia?

Answer 10

Low vitamin D
Raised ALP
Low Ca and P

XR: pseudofractures

Question 11

Management of osteomalacia?

Answer 11

Replace vitamin D and Ca: adcal D3