Paget's Disease of the Bone

Question 1

What is Paget’s disease of the bone?

Answer 1

It is an uncontrolled bone turnover due to a disorder of the osteoclasts

Question 2

How do osteoclasts & osteoblasts misbehave in Paget’s disease of the Bone?

Answer 2

Osteoclasts = resorb too much bone.

Osteoblasts = activity is too high (deposit too much bone)

Question 3

What is the prevalence of Paget’s disease of the Bone in the UK?

Answer 3

5%

(But only 1 in 20 are symptomatic)

Question 4

What are some predisposing factors fo Paget’s disease of the bone?

Answer 4

• Increasing age
• Male sex
• Northern latitude
• Family History

Question 5

What are some clinical features of Paget’s?

Answer 5

• Bone pain (e.g. pelvis, lumbar spine, femur)
• Classical, untreated features: bowing of tibia, bossing of skull.
• Raised ALP BUT calcium and phophate are normal.

Question 6

What are some complications of Paget’s disease?

Answer 6

• Deafness (cranial nerve entrapment)
• Bone sarcoma (1% if affected for > 10 years)
• Fractures
• Skull thickening
• High-output cardiac failure

Question 7

What are some indications for treatment in Pagets and what are the treatment options?

Answer 7

• Indications include bone pain, skull or long bone deformity, fracture or periarticular Paget’s.
• Treatment:
  
  • Bisphosphonates (oral risedronate or IV zoledronate)