Paget's Disease

Question 1

What is Paget’s disease?

Answer 1

Chronic disease that results in thickened, brittle and mis-shapen bones

Question 2

Who is affected by Paget’s disease?

Answer 2

Common

• Age related
• Affects elderly
• Rarely affects young

Question 3

What causes Paget’s disease?

Answer 3

Age related

Genetic Cause

Question 4

Describe the pathophysiology of Paget’s disease?

Answer 4

Increased bone reabsorption (increased osteoclast activity)

Compensation by increased bone production (increased osteoblast activity)

New bone is produced but it is brittle with thick cortices

Question 5

What bones are affected by Paget’s?

Answer 5

Femur

Tibia

Pelvis

Skull

Ear Ossicles

Question 6

Describe the symptoms of Paget’s?

Answer 6

Can be asymptomatic

Can cause arthritis

Can cause pathological fractures

Deformity

Pain

Question 7

Describe cardiac symptoms of Paget’s?

Answer 7

High output cardiac failure

Due to increased blood flow through Pagetic bone

Question 8

Describe ear symptoms of Pagets?

Answer 8

Can affect ear ossicles

Leads to conductive deafness

Question 9

Describe the biochemistry of Paget’s disease?

Answer 9

Normal Calcium

Normal Phosphate

Normal PTH

Increased ALP

Question 10

Describe what happens to ALP when there is active bone formation?

Answer 10

ALP rises when there is active bone formation

Question 11

Describe the radiological findings of Pagets?

Answer 11

Thickened cortices

Coarse bones

Areas of lysis and sclerosis

Question 12

Describe the results of a bone scan?

Answer 12

Increased uptake

Question 13

Treatment of Paget’s?

Answer 13

Biphosphonates

Calcitonin

Joint replacement

Fracture Stabilization

Question 14

What does this photo show?

Answer 14

Paget’s Disease

Areas of lysis and sclerosis

Deformity

Question 15

Give the biochemical results for osteoporosis?

Answer 15

Calcium Normal

Phosphate Normal

ALP Normal

PTH Normal

Question 16

Give the biochemical results for Osteomalacia?

Answer 16

Calcium Low

Phosphate Low

ALP high

PTH high

Question 17

Give the biochemical results for primary hyperparathyroidism?

Answer 17

Calcium normal

Phosphate decreased (high levels of PTH cause phosphate excretion)

ALP high

PTH high

Question 18

Describe the effect of high levels of PTH on phosphate in:

• Primary Hyperparathyroidism?
• Secondary Hyperparathyroidsim (Kidney Failure)

Answer 18

Primary: Cause phosphate excretion

Cause lower levels of phosphate

Secondary: Cannot cause increased phosphate excretion due to kidney failure. Phosphate levels increase

Question 19

Give the biochemical results for secondary hyperparathyroidism?

Answer 19

Calcium is low

Phosphate is high (can’t be excreted by kidneys)

ALP is high

PTH is high

Question 20

What do these results show?

Answer 20

Osteoporosis

Question 21

What do these results show?

Answer 21

Osteomalacia

Question 22

What do these results show?

Answer 22

Primary Hyperparathyroidism

Question 23

What do these results show?

Answer 23

Secondary Hyperparathyroidism

Question 24

What do these results show?

Answer 24

Paget’s Disease

Question 25

An 80-year-old man presents with pathological fracture of the femur. On X-Ray, the bones are thickened and mis-shapen. Blood tests reveal normal calcium, normal phosphate, high ALP and normal PTH. What condition does he have?

Answer 25

Paget’s Disease

Question 26

What is Calcitonin given for in Paget’s?

Answer 26

Slows down bone remodelling (Inhibits osteoclast activity)