21-PAGET’S DISEASE OF THE BONE

• Paget's disease


  A disorder of bone remodeling in which there is increased osteoclastic bone resorption followed by formation of weaker new bone, increasing the local bone blood flow and fibrous tissue
• Paget's disease


  • Most common sites are the pelvis, femur, lumbar spine, skull, tibia
  • Pain in the bone or nearby joint
  • Deformities: enlargement of the skull, bowing of the tibia
  • Complications: nerve compression (deafness, paraparesis), pathological fractures, high output cardiac failure (due to increased bone blood flow), osteogenic sarcoma
• Investigations


  • Raised serum alkaline phosphatase concentration (>1000 U/L) with a normal calcium & phosphate
  • Raised urinary hydroxyproline excretion (used as marker of disease activity)
  • X-rays: localized bony enlargement and distortion, sclerotic changes, and osteolytic areas
  • Radionuclide bone scans: increased uptake of bone-seeking radionuclides
• Treatment: Bisphosphonates