Paget’s disease of bone is characterized by one or more bony lesions having high bone turnover and disorganized osteoid formation.
Involved bone becomes vascular, weak, and deformed.
• It is the disease of the elderly seldom seen before age 40, mostly identified incidentally on radiography or raised alkaline phosphatase
• The pelvis, femur, tibia, lumbar spine, skull, and scapula are principally affected.
• The primary abnormality is increased osteoclastic bone resorption which is accompanied by marrow fibrosis,
increased vascularity of bone and decreased osteoblastic activity.
• Genetic factors are clearly important and family history is present in about 15% of
• The classic presentation is bone pain, deafness, and pathologic fractures.
• The bones become soft, leading to bowed tibias, kyphosis, and frequent fractures with
• If the skull is involved, the patient may report headache, increased hat size, and deafness because affected bones enlarge and encroach the nerve foramina.
• Increased vascularity over-involved bone causes increased warmth and can precipitate high cardiac output failure.
• Osteosarcoma is a rare complication.
• Serum calcium and phosphate are normal but serum alkaline phosphatase is markedly high.
• X-rays: the involved bone is expanded and denser than normal.
Multiple fractures may be present in long bones.
A bone scan can detect the disease even before any x-ray changes are apparent.
• Fractures on minimal trauma.
• Kidney stones if there is immobilization.
• Spinal cord compression due to vertebral collapse.
• Osteosarcoma in long-standing cases.
• High output cardiac failure due to increased vascularity.
• Cranial nerve palsies and stroke due to skull involvement.
– Refer to endocrinologist