Pathological fractures

Question 1

What are some causes of pathological fractures

Answer 1

Osteoporosis 
Osteomalacia 
Bone cancers and tumours/ Bony metastases 
Bone cysts 
Pagets disease of bone 
Osteogenesis imperfecta

Question 2

What is a pathological fracture

Answer 2

It is a fracture caused by weakened bone structure. They often happen in atypical locations and under very low force trauma

Question 3

What is Pagets disease of bone

Answer 3

A chronic condition leading to abnormal formation of bone
Excessive breakdown and reformation due to increased osteoblast and osteoclast activity leads to disorganised bone remodelling
Often only present in a few bones in the body

Question 4

What are the causes of Pagets

Answer 4

Genetic - autosomal dominance

Viral infection

Question 5

How does it present

Answer 5

Commonly asymptomatic
Often suspected in pathological bone fractures
Signs and symptoms
- bone pain
- possible bone deformity
- Raised skin temp over the active bone formation/remodelling

Question 6

What are the complications of Pagets disease of bone

Answer 6

Increased risk of fracture - bone in pagets disease is highly vascular so pathological fractures bring a greater risk of bleeding to death
Bone deformity
OA - more likely if pagets disease is near a joint
Deafness and tinnitus - due to abnormal shape of the skull
Spinal stenosis and nerve compression
Increased total peripheral resistance due to increased vasculature - can lead to HF

Question 7

How is pagets disease of the bone investigated

Answer 7

Bloods
- raised ALP
- Raised Ca and Phosphate with raised ALP show bone cause
However pagets often has a raised ALP with normal Calcium and Phosphate

X-Rays of symptomatic areas 
Osteolysis - destruction of bone tissue 
Excessive bone formation 
V shaped pattern between healthy and diseased long bone  
Cotton wool pattern in the skull 

Biopsy to rule out malignant cause

Question 8

How is Pagets disease of the bone managed?

Answer 8

Control of pain - NSAIDs and paracetamol
Monitoring on a regular basis - more likely to develop osteosarcoma
Sticks, walkers and leg supports may be relevant in patients with weakened tibias
Bisphosphonates may be used to try and slow or cease the cycling of bone - treat any calcium or vit D deficiencies first
Nerve compression may need surgery