Paget's Disease

Question 1

What disease is caused by increased osteoclastic resorption and abnormal new bone formation?

Answer 1

Paget’s disease; thought to be caused by a viral infection

Question 2

What is the incidence of Paget’s sarcoma?

Answer 2

< 1%; osteosarcoma is most common, followed by fibrosarcoma and chondrosarcoma; treat with chemo and wide resection

Question 3

What is the radiographic appearance of Paget’s disease?

Answer 3

May see increased lytic and blastic areas with thickened cortex; may present with fractures, cotton wool exudates on skull radiograph

Question 4

What are the laboratory and histiologic findings in Paget’s disease?

Answer 4

1) elevated serum alkaline phosphatase
2) elevated urine hydroxyproline
3) Normal calcium
4) woven bone with large irregular trabeculae and disorganized cement lines
5) virus like inclusion bodies

Question 5

What medication is contraindicated in the treatment of Paget’s disease?

Answer 5

teriperatide (Forteo); is a recombinant form of PTH that increases risk for secondary sarcoma

Question 6

What are treatment options for Paget’s disease?

Answer 6

Oral agents: Alendronate, risendronate, etidronate
IV agents: zoledronic acid, pamidronate
calcitonic used to shrink osteoclasts

Question 7

What considerations should be made when performing hip and knee arthroplasty in Paget’s disease?

Answer 7

Increased risk for malalignment in TKA

Pretreat with bisphosphonates to decrease risk of bleeding in THA; increased risk of loosening in THA