PAGET'S DISEASE OF THE BONE


I. Pathophysiology and clinical features
  1. Localized areas (usually multiple) of osteoclast-mediated bone resorption, followed by ineffective osteoblastic activity
  2. Usually after 40yo
  3. Slight male predominance
  4. Most commonly affected areas are pelvis, lumbar spine, femur, and thoracic spine (respectively)
  5. Usually asymptomatic and discovered incidentally on x-rays
  6. Can cause pain (usually deep, aching, constant, worse at night)
  7. Can cause distortion of skull, jaw, clavicle, and long bones
  8. Can eventually see fractures, which do not heal easily
  9. Osteosarcoma (rare; < 1% of pts)
  10. Can be associated with elevated serum alkaline phosphatase
II. Management
  1. If asymptomatic, no treatment is required
  2. Bone pain often responds to acetaminophen or NSAIDs
  3. For severe pain or complications (e.g. skull deformity causing neurologic complications), or fracture, treat with meds (bisphosphonates)
(Sources include Core Content Review of Family Medicine, 2012)