Pagets disease of the bone Flashcards
underlying problem
increased bone turnover due to overactive osteoblasts and osteoclasts
is the excessive turnover coordinated? result
no
patchy areas of high density and low density
what happens to the bones?
enlarged and misshapen
prone to pathological fractures
what bones are affected?
axial
presentation
bone pain
bone deformity
fractures
hearing loss
Key investigations
x-ray
bloods - alkaline phosphatase, calcium and phosphate
x-ray findings
bone enlargement and deformity
cotton wool appearance of skull
v shaped defects in long bones
osteoporosis circumscripta
what blood marker is increased?
alk phos
main treatment
bisphosphonates
other treatment
NSAIDs
calcium and vitamin D
surgery
physio, orthotics, aids
monitoring
serum ALP
Two key complications
osteogenic sarcoma - osteosarcoma
spinal stenosis and SCC
osteosarcoma
poor prognosis
increased focal bone pain, bone swelling or #
spinal stenosis
narrowing of canal
MRI scan treat with bisphosphonates
surgery
neurological symptoms
hearing loss chronic facial pain hydrocephalus peripheral nerve entrapment spinal stenosis
