PAGET'S DISEASE

Question 1

What is Paget’s disease?

Answer 1

Excessive breakdown and formation of bone, followed by disorganized bone remodelling. This causes affected bone to weaken, resulting in pain, misshapen bones, fractures and arthritis in the joints near the affected bones. The skull, axial skeleton and long bones are the most commonly affected bones.

Question 2

How is it diagnosed?

Answer 2

Plain X-ray:
Localised enlargement of bone. Patchy cortical thickening, sclerosis, osteolysis and deformity.

Bone scan:
May reveal “hot spots”.

Bloods:
Calcium and phosphate normal, ALP markedly raised.

Question 3

How is it treated/managed?

Answer 3

The goal of treatment is to relieve bone pain and prevent the progression of the disease.

 Analgesia
 Bisphosphonates and calcitonin

Question 4

What are the signs/symptoms?

Answer 4

 Asymptomatic in 70%.
 Deep, boring pain in bones
 Bony deformity and enlargement

Question 5

What are some complications of the disease?

Answer 5

	Pathological fractures
	Osteoarthritis 
	Increased Ca2+
	Nerve compression due to bone overgrowth 
	Osteosarcoma

Question 6

What causes Paget’s disease?

Answer 6

The exact cause of the disease is unknown, although genetics and certain viral infections may play a role.