Pagetβs 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 βcotton woolβ 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)