Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Updated: Dec 26 2021

Paget Disease of Bone (Osteitis Deformans)

Images disease.jpg scintigraphy paget disease..jpg
  • Snapshot
    • A 60-year-old man presents to his primary care physician with hip pain and hearing loss. He denies any trauma to the hip or any recent changes in his medications. He also notes his hat fits tighter than before. Physical examination is unremarkable. Laboratory testing is significant for an elevated alkaline phosphatase level in the setting of normal serum calcium, phosphate, and parathyroid hormone.
  • Introduction
    • Clinical definition
      • a progressive metabolic bone disorder of abnormal bone remodeling
        • excessive bone resorption and formation is present
  • Epidemiology
    • incidence
      • second most common metabolic bone disorder (osteoporosis is first)
    • age
      • > 55 years of age
  • Etiology
    • Unknown
    • Pathogenesis
      • increased multinucleated osteoclastic and osteoblastic activity leads to a high bone remodeling rate resulting in abnormal bone architecture (lytic and blastic lesions)
  • Presentation
    • Symptoms
      • usually asymptomatic
      • bone and/or joint pain
      • bone deformity
        • bowing deformity
      • hearing loss
        • with skull involvement that leads to narrowing of the auditory foramen
    • Physical exam
      • typically unremarkable
  • Imaging
    • Radiography
      • indication
        • to identify osteolytic, osteoblastic, and sclerotic bone changes
    • Bone scintigraphy
      • indication
        • to determine the extent of Paget disease of bone and to assess for other sites of involvement
  • Studies
    • Labs
      • normal serum phosphate, calcium, and parathyroid hormone
      • elevated alkaline phosphatase
    • Histology
      • mosaic pattern of lamellar bone with prominent cement lines
  • Differential
    • Laboratory Abnormalities in Select Bone Disorders
      Serum Phosphate
      Serum Calcium
      Serum Alkaline Phosphatase
      Parathyroid Hormone
      OsteopetrosisNormalNormal or decreasedNormalNormal
      Paget disease of the boneNormalNormalIncreasedNormal
      Osteitis fibrosa cysticaPrimary
      • decreased
      • increased

        • increased

        • decreased

          Primary and secondary hyperparathyroidism
          • increased
            Primary and secondary hyperparathyroidism
            • increased
              Hypervitaminosis DIncreasedIncreasedNormalDecreased
          • Treatment
            • Medical
              • bisphosphonates
                • indication
                  • first-line treatment for Paget disease of bone
            • Surgical
              • orthopedic surgery (e.g., joint/knee arthroplasty)
                • indication
                  • to manage symptomatic complications of Paget disease of bone (e.g., osteoarthritis, pathologic and pseudofractures, and spinal stenosis)
          • Complications
            • Neurologic
              • nerve root compression
              • hearing loss
              • spinal stenosis
            • Orthopedic
              • pathologic fractures
              • secondary osteoarthritis
            • Oncologic
              • osteosarcoma
            • Cardiovascular
              • high-output heart failure
                • abnormal bone deposition leads to increased bony vascularization, which decreases systemic vascular resistance (afterload), leading to high-output heart failure
          • Prognosis
            • Expansion of untreated Paget lesions
          1 of 0
          1 of 8
          Private Note

          Attach Treatment Poll
          Treatment poll is required to gain more useful feedback from members.
          Please enter Question Text
          Please enter at least 2 unique options
          Please enter at least 2 unique options
          Please enter at least 2 unique options