Paget's

Question 1

Cause of Paget’s disease

Answer 1

• increased but uncontrolled bone turnover
• excessive osteoclastic resorption followed by increased osteoblastic activity.

Question 2

Which bones are most commonly affected with paget’s disease

Answer 2

skull
spine
pelvis
long bones of the lower extremities

Question 3

Predisposing factors

Answer 3

increasing age
male sex
northern latitude
family history

Question 4

What percentage of patients with Paget’s are symptomatic?

Answer 4

5%

Question 5

Stereotypical patient

Answer 5

• older male
• bone pain
• isolated raised ALP

Question 6

If symptomatic, what are the main clinical features?

Answer 6

bone pain (e.g. pelvis, lumbar spine, femur)

classical, untreated features: bowing of tibia, bossing of skull

Question 7

Typical blood test results

Answer 7

raised ALP
calcium/phosphate = normal Hypercalcaemia with prolonged immobilisation

Question 8

Markers of bone turnover

Answer 8

• procollagen type I N-terminal propeptide (PINP)
• serum C-telopeptide (CTx)
• urinary N-telopeptide (NTx)
• urinary hydroxyproline

Question 9

XR findings in Paget’s

Answer 9

osteolysis (early)
mixed lytic/sclerotic lesions (late)

skull = thickened vault, osteoporosis circumscripta

Question 10

Indications for treatment in Pagets disease

Answer 10

• bone pain
• skull or long bone deformity
• fracture
• periarticular Paget’s

Question 11

Management of Paget’s

Answer 11

bisphosphonate
calcitonin is less commonly used now

Question 12

Complications of Paget’s Disease

Answer 12

deafness (cranial nerve entrapment)
bone sarcoma
fractures
skull thickening
high-output cardiac failure