Paget's disease of the Bone ☺️

Question 1

Description and pathophysiology
Epidemiology
Risk factors

Answer 1

Increased uncontrolled bone turnover
-excess osteoclast resorption followed y increased osteoblast activity

Common but symptomatic in 1 in 20

Old man
Northern
FHx

Question 2

Presentation

Investigations

Answer 2

Bone pain
-skull, spine, pelvis, femur)
Tibia bowing, skull bossing

Isolated high ALP
Can, PO4 normal
High PINP, CTx, NTx, urinary hydroxyproline (markers of increased bone turnover)
Skull Xray - thickened skull cap, osteoporosis circumscripta

Question 3

Management - pharmacological

Answer 3

Bisphosphonate - PO risendronate/IV zolendronate

Calcitonin less commonly used

Question 4

Complications

Answer 4

Deafness - CNVIII nerve entrapment
Bone sarcoma
Fractures
Skull thickening
High output cardiac failure