Paget's Disease

Exam Cram

• Presentation: usually monoarthritis

• Isolated raised alkaline phosphatase (normal calcium, phosphate and PTH)

• XR joint destruction with sclerotic bone

• Management (1)- Bisphosphonates

Outline

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

• Biopsy: polynucleated neutrophils

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

Management

1.  Bisphosphonates

2.   Denosumab

References and Resources

Written in 2025