Pagets Disease of Bone

Question 1

What is paget’s disease of bone?

Answer 1

Increased uncontrolled bone turnover. Primarily disorder of osteoclasts resulting in increased bone resoprtion; increases osteoblastic activity then follows

Question 2

State some risk factors for pagets disease of the bone

Answer 2

• Male
• FH
• Increasing age

Question 3

Describe typical presentation of pagets disease of the bone

Answer 3

• Bone pain
• Isolated raised ALP
• If untreated for long duration: bowing of tibia, bossing of skull

Question 4

What would you find on the following investigations in pagets disease of the bone:
- LFTs
- Bone profile
- X-ray
- Bone scintigraphy

Answer 4

• LFTS: isolated raised ALP
• Bone profile: normal calcium & phosphate
• TFTS: normal
• X-ray: osteolysis in early disease with mixed lytic/sclerotic lesions later. Skull may show thickened vault.
• Bone scintigraphy: increased uptake at sites of active bone lesions

Question 5

Discuss the management for paget’s disease of the bone

Answer 5

Bisphosphonates are first line

Question 6

State some indications for treatment in pagets disease of the bone

Answer 6

• Bone pain
• Skull or long bone deformity
• Fracture
• Periarticualr pagets

Question 7

State some potential complications of pagets disease of the bone

Answer 7

• Deafness (due to cranial nerve entrapment)
• Bone sarcoma
• Fractures
• Skull thickening
• High output cardiac failure