Paget's disease of the bone

Question 1

Describe the presentation of Paget’s disease of the bone?

Answer 1

Often asymptomatic
Severe pain in the long bones or facial areas
Bowing of the long bones
Visible frontal bossing / prognathism
Spinal stenosis

Question 2

What investigations are conducted in Paget’s disease of the bone?

Answer 2

Plain x-ray - initially lytic lesions, then no features, then sclerotic lesions
Bone scan
Increased ALP
LFTs - to rule out liver causes of raised ALP
Serum calcium
Serum P1NP - measures bone formation
Serum CTX - measures bone resorption
Serum 25-hydroxvitamin D - to rule out osteomalacia
Bone biopsy

Question 3

How is Paget’s disease of the bone managed?

Answer 3

Observation, regular follow-up, education and preventative measures (avoid high input activities)
Bisphosphonates, calcitonin, physio, orthoses

Question 4

What are the potential complications of Paget’s disease of the bone?

Answer 4

• Arthritis
• Hearing loss and/or tinnitus
• Spinal stenosis
• Osteosarcoma
• Hypercalcaemia
  
  • Kidney stones
  • High-output cardiac failure
• Pathological fractures
• Excessive bleeding and heterotypic ossification
• Hydrocephalus