Paget's Disease

Exam Cram

• Paget's disease is defined by increased osteoblast and osteoclast activity, the new bone growth is less stable and cause arthritis/ bone pain

• Presentation: usually monoarthritis, isolated raised alkaline phosphatase (normal calcium, phosphate and PTH), XR joint destruction with sclerotic bone

• Diagnosis: increased uptake on scintigraphy

• Management: (1)- Bisphosphonates

Outline

Background

Assessment

History

• MSK pains in e.g. lower back and pelvis

• Elderly man

Examination

• Usually mono-arthritis

Investigations

• Raised Alk P (can be significantly elevated)

• Normal calcium/ phosphate and parathyroid hormone

• XR: cortical thickening, boney sclerosis

• Scintigriphy: increased radio-iodine uptake

• Biopsy: polynucleated neutrophils

Diagnosis

Differentials

Conditions Differentiating features

• Osteomalacia Low Ca/ PO4/3, raised PTH, polymyopathy

• Hyperparathyroidism Raised PTH

• Avascular necrosis: Associated with steroid use/ other risk factors

• Osteoporosis Normal biochemistry, asymptomatic

• Metastatic cancer Raised calcium/ phosphate

• Osteoarthritis Normal Alk P

Diagnosis: scintigraphy scan shows increased bone uptake, a bone biopsy can be done if diagnostic uncertainty

Management

Acute & chronic

1.  Bisphosphonates & analgesia

2.  Denosumab

References and Resources

Written in 2025