Paget's Disease Of Bone Flashcards
Define Paget’s Disease of bone?
Characterised by excessive bone remodeeling at one (monostatic) or more (polyostatic) sites resulting in bone that is structurally disorganised
What is the aetiology of Paget’s Disease?
Genetic factors and virla infection may play a role
Excessive bone resorption by abnormally large osteoclasts is followed by increased bone formation by osteoblasts in a disorganised fashion
This results in an abnormal pattern of lamellar bone
Marrow spaces are filled by an excess of fibrous tissue with a marked increase in blood vessels
What is the epidemiology of Paget’s Disease?
Common in ELDERLY
3% of > 50 yrs
10% of > 80 yrs
Males = Females
What are the presenting symptoms of Paget’s Disease?
May be Asymptomatic May present with insidious onset pain, which is aggravated by weight bearing and movement Headaches Deafness Increasing Skull size
What are the presenting symptoms of Paget’s Disease?
May be Asymptomatic May present with insidious onset pain, which is aggravated by weight bearing and movement Headaches Deafness Increasing Skull size
What are the signs of Paget’s Disease on physical examination?
Bitemporal skull enlargement with frontal bossing
Spinal Kyphosis
Anterolateral bowing of femur, tibia or forearm
Skin over the affected bone may be warm
Sensorineural deafness
What is frontal bossing?
Prominent, protruding forehead
Why might skin over the affected bone be warm in Paget’s Disease?
Due to increased vascularity
Why might there be Sensorineural Deafness in Paget’s Disease?
Due to compression of vestibulocochlear nerve
What bloods would you do for Paget’s Disease and what might you expect?
High ALP
Ca2+ and phosphate = NORMAL
What might you see on a Bone Radiograph for Paget’s Disease?
Enlarged, deformed bones
Lytic and Sclerotic Appearance
Lack of distinction between cortex and medulla
Skull Changes
What skull changes might you see on a Bone Radiograph in Paget’s Disease?
Osteoporosis Circumscripta
Enlargement of frontal and occipital areas
Cotton Wool appearance
Why do we do a Bone Scan for Paget’s Disease?
Assesses extent of skeletal involvement
Pagetic bone lesions appear as areas with markedly increased uptake
Why do we look at Resorption Markers for Paget’s Disease?
Monitors disease activity
Check urinary hydroxyproline
