Paget's Disease of the Bone

Question 1

What is Paget’s Disease of the Bone?

Answer 1

Disorder of bone turnover, excessive formation and reabsorption due to excessive activity of osteoblasts and osteoclasts.

Question 2

Why does Paget’s Disease of the Bone leave patchy areas of high density and low density bone and what does it cause?

Answer 2

Because the excessive bone turnover is not co-ordinated. Causes enlarged and misshapen bones, increased risk of pathological fractures (particularly in axial skeleton).

Question 3

What is this a presentation of?

Older adult, bone pain and deformity, fractures.

Answer 3

Paget’s Disease of the Bone

Question 4

What are the x-ray findings in Paget’s Disease of the Bone?

Answer 4

1. Bone enlargement and deformity
2. ‘Osteoporosis circumscripta’ - lesions appearing less dense
3. ‘Cotton wool’ appearance of skull
4. ‘V-shaped defects’ in long bones - osteolytic lesions

Question 5

What are the biochemistry findings in Paget’s Disease of the Bone?

Answer 5

1. Raised ALP (other LFTs normal)

2. Normal calcium and phosphate

Question 6

How is Paget’s Disease of the Bone managed?

Answer 6

1. Bisphosphonates - generally very effective
2. NSAIDs, calcium, vitamin D
3. Rarely surgery

Question 7

How is Paget’s Disease of the Bone monitored?

Answer 7

Check serum ALP and review symptoms, affective treatment should normalise both.

Question 8

What are the two major complications of Paget’s Disease of the Bone?

Answer 8

1. Osteogenic sarcoma - bone cancer (plain x-ray)

2. Spinal stenosis - compression on spinal nerves causes neurological issues (MRI)