Table of Contents
Paget’s disease is caused by increased bone remodelling by osteoclasts and osteoblasts. This results in in bone enlargement, pain, deformity and weakness. The cause is unknown.
Epidemiology
- 1-2% of white >55 year olds
- High incidence in UK; low incidence in Asia
Investigations
- Imaging: plain X-rays (bone enlargement and ‘cotton wool’ lytic/sclerotic pattern), bone scan (scintigraphy/technetium scan)
- Blood tests: ALP (increased), calcium/phosphate/vitamin D (all normal)
- Other tests: urine/serum hydroxyproline, urine pyridinoline, serum procollagen I N-terminal peptide (PINP)
Clinical features
Symptoms
- Bony pain
- Pathological fractures
Signs
- General inspection
- Kyphosis
- Paraplegia (spinal disease)
- Bone pain
- Hands inspection
- Osteoarthritis
- Face
- Frontal bossing of skull
- Nerve deafness and tinnitus (due to bony compression of CN8)
- Enlarged maxilla
- Neck
- Raised JVP (heart failure due to hyperdynamic circulation)
- Legs
- Bowed femur
- Sabre (bowed) tibia
- Feel warm
- Pathological fractures
- Osteoarthritis
Management
- Analgesia (e.g. NSAIDs and paracetamol)
- Bisphosphonates (e.g. zoledronic acid)
- Ensure adequate vitamin D and calcium intake
- Physiotherapy and orthotic devices
Test yourself
Which complications may be related to Paget’s disease?
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What are Angioid streaks?
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