Paget's disease of the bone

Question 1

What is Paget’s disease of the bone?

Answer 1

A disorder of uncontrolled bone turnover, due to excessive osteoclast resorption and increased osteoblast activity

Question 2

What are the risk factors for Paget’s disease?

Answer 2

Increasing age
Male sex
Northern latitude
Family history

Question 3

What is the clinical presentation of Paget’s disease?

Answer 3

Bone pain
Bone deformity
Fractures
Hearing loss

Question 4

What are the XR findings in paget’s disease?

Answer 4

Bone enlargement and deformity
Osteoporosis circumscripta - well defined osteolytic lesions
Cotton wool appearance of skull
V shaped osteolytic defects in long bones

Question 5

What investigations are used in diagnosis of Paget’s disease?

Answer 5

ALP - raised
Calcium - normal
Phosphate - normal
XR

Question 6

What is the mainstay of treatment for Paget’s disease of the bone?

Answer 6

Bisphosphonates

Question 7

What is the second line management of Paget’s disease of the bone?

Answer 7

Calcitonin
Analgesia for bone pain
Calcium and vitamin D supplementation

Question 8

What are the indications for treatment with bisphosphonates?

Answer 8

Bone pain
Skull or long bone deformity
Fracture
Periarticular Paget’s

Question 9

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

Answer 9

Hearing loss (if affects the bones of the ear)
Fractures
Skull thickening
Heart failure (due to hypervascularity of abnormal bone)
Spinal stenosis