Paget’s Disease

Question 1

What is Paget’s disease?

What happens to the bones in this disease?

Answer 1

Metabolic bone disorder where there is increased bone turnover due to increased number and activity of osteoblasts and osteoclasts

The excessive activity is NOT coordinated meaning there might be areas of increased resorption (lysis) and areas of increased bone laying (sclerosis)

Bones become enlarged and misshapen
(Increased risk of fractures)

Question 2

How might someone with Paget’s disease present?

Answer 2

Bone pain

Bone deformity

Fractures

Hearing loss
-bone overgrowth can lead to compression of vestibular nerve

Question 3

What investigations would you do if someone was suspected of having Paget’s disease?
What would you expect to find?

Answer 3

U+Es
-normal calcium and phosphate= rules out osteomalacia but could still be osteoporosis

LFTs

• raised ALP = differentiates from osteoporosis when calcium and phosphate normal
• rest normal

XRAY

• bone enlargment
• osteoporosis circumscripta= osteolytic lesions i.e. less dense than normal bone
• patchy sclerosis and lysis
• cotton wool skull
• v-shaped defects on long bones i.e. due to osteolytic lesions forming in healthy bone

Question 4

What are the management options for Paget’s disease?

What is measured to determine if treatment effective?

Answer 4

Bisphosphonates
-interfer with osteoclast activity and aim to try and restore normal bone metabolism

NSAIDs
-bone pain

Calcium and Vit D
-whislt on bisphosphonates

ALP measured
-levels should normalise

Question 5

What complications can occur with Paget’s disease?

Answer 5

Oestosarcoma

Spinal stenosis + spinal cord compression