Paget's disease

Question 1

P

Answer 1

Abnormal production of mechanically weak bone
Pelvis, spine, skull, femur, tibia

Lytic phase - increased osteoclast activity - raised ALP
Mixed phase - increased bone turnover - osteoclast and blast activity - deposition of structurally abnormal bone
Sclerotic phase - chronic sclerotic phase - bone formation > bone resorption

Question 2

A

Answer 2

55
Male
Caucasian
FHx

Question 3

CF

Answer 3

Bone pain
Bone deformity: tibia bowing
Increased temperature
Pathological fractures
Secondary osteoarthritis
Hearing loss/tinnitus - affects skull bones

Question 4

Ix

Answer 4

Raised ALP
Normal calcium
Normal phosphate

X-rays - localised enlargement
Cortical thickening
Sclerosis
Osteolysis
Lytic lesions in long bones

Question 5

Mx

Answer 5

Orthotics
Calcium/vit D

Bisphosphonates - risedronate
NSAIDs and paracetamol for pain relief

Surgical:
Fracture fixation, joint replacement, osteotomy