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)
  • Bisphosphonates (e.g. alendronic acid)
  • Ensure adequate vitamin D and calcium intake
  • Physiotherapy

Test yourself

Which complications may be related to Paget’s disease?

Oops! This section is restricted to members.

Create an account or log in to continue reading.

What are Angioid streaks?

Oops! This section is restricted to members.

Create an account or log in to continue reading.

Join our email list!
For free OSCE tips and updates