Table of Contents EpidemiologyInvestigations Clinical features SymptomsSignsManagement Test yourself 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) LegsBowed femurSabre (bowed) tibiaFeel 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? Oops! This section is restricted to members. What are Angioid streaks? Oops! This section is restricted to members.