Paget Disease

also see Other bone disorder (Labs) 
Accelerated bone turnover and remodeling, resulting in impaired bone integrity and overgrowth.

SYMPTOMS

EXAM

DIFFERENTIAL

DIAGNOSIS

TREATMENT

COMPLICATIONS

RHEUMATOLOGIC NEUROLOGIC CARDIAC NEOPLASTIC METABOLIC
Osteoarthritis Deafness (from involvement of cranial nerves with bony entrapment) High-output CHF Osteosarcoma or chondrosarcoma Immobilization-induced
hypercalcemia/
hypercalciuria
 
Gout Spinal cord compression leading to paraplegia
Peripheral nerve entrapment (carpal and tarsal
tunnel syndromes)
  Giant cell tumor Nephrolithiasis

X-ray of Paget disease of the tibia

X-ray of Paget disease of proximal femur


ITE 2013, Q86
A 54-year-old male presents with progressively worsening pain just below his right knee. He describes the pain as deep and aching, and says it is always present throughout the day, even while he is at rest, and worsens at night. Weight bearing intensifies the pain, as does heat. The patient does not recall any injury or other reason for the leg to hurt. He has not had any fever. His family history is positive for osteoarthritis in both parents when they were older, and an uncle has had a knee replacement. A physical examination is negative except for some varus deformity of the right lower extremity just below the knee. There is no redness. Radiographs demonstrate mild to moderate bowing of the proximal tibia. His alkaline phosphatase level is elevated but his -glutamyl transaminase level is normal. The remainder of a comprehensive metabolic panel is also normal. A CBC is normal, including the WBC count and differential.

You should suspect which one of the following conditions?

A) Osteoarthritis
B) Osteoporosis
C) Osteomyelitis
D) Paget’s disease of bone
E) Seronegative spondyloarthritis