Paget's Disease of the Bone

Question 1

What is Paget’s disease of the bone?

Answer 1

Excessive osteoclastic reabsorption followed by increased osteoblastic activity

Question 2

What parts of the body does Paget’s affect? (in order)

Answer 2

Spine
Skull
Pelvis
Femur

Question 3

How does Paget’s present?

Answer 3

• Bone pain
• Bone deformities
• Bowing of femur and tibia
• Bone affected feels warm
• Pathological fracture
• Hearing loss

Question 4

What symptoms would present if Paget’s disease affected the breast?

Answer 4

Itchy
Erythematous
Scaly rash affecting the nipple and areola

Question 5

How is Paget’s disease diagnosed?

Answer 5

X-ray
Excessively raised ALP
Normal serum calcium, serum phosphate and PTH

Question 6

What would you see on an x-ray of someone with Paget’s disease of the bone?

Answer 6

Osteoporosis circumscripta (lytic lesions) 
Cotton wool appearance

Question 7

How would a typical patient with Paget’s present?

Answer 7

Bone pain
Deaf
Skull x-ray shows thickened vault

Question 8

What are possible complications of Paget’s disease?

Answer 8

• Osteosarcoma
• Spinal stenosis and nerve compression
• Deafness due to nerve compression
• High output cardiac failure

Question 9

What will be excessively raised in Paget’s?

Answer 9

ALP

Question 10

What is the management of Paget’s disease?

Answer 10

Bisphosphonates

Question 11

Which bisphosphonates might be used in the management of Paget’s disease?

Answer 11

Oral risedronate

IV zoledronate