Pagets Flashcards
(8 cards)
What is Paget’s disease of the bone?
uncontrolled bone turnover
excessive uncoordinated bone turnover (formation and resorption) due to excessive activity of mainly osteoclasts and also osteoblasts . Leads to patchy areas of high density (sclerosis) and low density (lysis)
results in bone enlargement and deformity causing structural problems = > risk of fractures
Which bones does paget’s disease especially effect?
- Axial skeleton - bones of the head and spine
- Pelvis
- Lone bones of the lower extremities
How does Pagets disease present?
stereotypical: older male with bone pain and isolated ALP
- Bone pain
- Bone deformity - classical: bowing of tibia, bossing of skill (if left untreated)
- Raised ALP
- Other features of bone turnover: PINP, CTx, NTx, urinary hydroxyproline
What are the potential complications of Paget’s disease?
- deafness (cranial nerve entrapment)
- Bone sarcoma (1% if affected for >10 years)
- Fractures
- Skull thickening
What are the risk factors for Paget’s disease
increasing age
male sex
northern latitude
family history
What investigations would you do?
- X-ray
- ALP - raised (other LFTs normal)
- Calcium (normal)
- Phosphate (normal)
What findings would you see on X-ray?
- bone enlargement and deformity
- Osteoporosis Circumscripta - well defined osteolytics lesions, appear less dense than darker bone
- Cotton wool appearance of skull (lytic and sclerotic regions)
- skull thickening
What is the management of Paget’s Disease?
Bisphosphonates (Risedronate or IV Zoledronate)