Paget's Disease of Bone and Osteomyelitis

Question 1

general paget’s info

Answer 1

uncommon, chronic bone disease

etiology unknown (affects osteoclasts?)

rapid isolated bone repair, enlarged bone but soft bones

Question 2

what are pts w/ paget’s disease susceptible to?

Answer 2

fractures and arthritis

Question 3

diagnostic studies for paget’s disease

Answer 3

Detected incidentally on x-ray
(pelvis, lumbar spine, hips, femurs, skull)

Serum alkaline phosphatase (ALP) elevated! (bone and liver, shows rapid new bone turnover)

Bone scan- shows extent of bone involvement

Question 4

sxs of paget’s disease of bone

Answer 4

asymptomatic
(pain due to bone overgrowth)

bowing out of leg

Question 5

tx of paget’s disease

Answer 5

Acetaminophen or NSAIDS

bisphosphonates if severe -Reclast (Zoledronic acid) IV

Surgery for arthritis caused from Paget’s disease is effective in reducing pain and improving function

Question 6

Osteomyelitis caused by:

Answer 6

serious bone infection caused by Hematogenous spread of bacteria

The most common region of bone is metaphysis

In children, long bones affected more commonly

In adults, vertebrae affected most commonly

Question 7

what pts are at risk for developing osteomyelitis

Answer 7

immunocompromised patient
Trauma
IV drug users
Sickl cell Disease
DM
elderly

Question 8

osteomyelitis is also associated w. what other disease

Answer 8

vascular insufficiency

Pts w/ DM & chronic vascular insuff. at risk for this type of osteomyelitis
Very challenging infection
Foot and ankle most common

think ulcers, chronic poor healing

Question 9

sign and sxs of osteomyelitis

Answer 9

sudden high fever, chills
pain, tenderness
localized skin infection
ulcers (ability to pass sterile problem through ulcer to bone)

Question 10

what is the most sensitive test to show the extent to infection in osteomyelitis

Answer 10

MRI

also gather labs, bone biopsy, x-ray

Question 11

Treatment for osteomyelitis

Answer 11

surgery

IV ABX