Paget's disease is a disease of increased but uncontrolled bone turnover. It is thought to be primarily a disorder of osteoclasts, with excessive osteoclastic resorption followed by increased osteoblastic activity. Paget's disease is common (UK prevalence 5%) but symptomatic in only 1 in 20 patients
Predisposing factors
§ Increasing age
§ Male sex
§ Northern latitude
§ Family history
Clinical features - only 5% of patients are symptomatic
· Bone pain (e.g. Pelvis, lumbar spine, femur)
· Classical, untreated features: bowing of tibia, bossing of skull
· Raised alkaline phosphatase (alp) - calcium* and phosphate are typically normal
· Skull x-ray: thickened vault, osteoporosis circumscripta
Indications for treatment include bone pain, skull or long bone deformity, fracture, periarticular Paget's
· Bisphosphonate (either oral risedronate or iv zoledronate)
· Calcitonin is less commonly used now Complications
· Deafness (cranial nerve entrapment)
· Bone sarcoma (1% if affected for > 10 years)
· Fractures
· Skull thickening
· High-output cardiac failure
Usually normal in this condition but hypercalcaemia may occur with prolonged immobilisation Paget's disease - old man, bone pain, raised ALP. The normal calcium and phosphate combined with a raised alkaline phosphate points to a diagnosis of Paget's