{"id":5590,"date":"2013-02-20T22:55:26","date_gmt":"2013-02-20T22:55:26","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/paget\/"},"modified":"2025-05-13T20:27:59","modified_gmt":"2025-05-13T20:27:59","slug":"paget","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/paget\/","title":{"rendered":"Diagnosis of Paget&#8217;s Disease of Bone"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>Paget&#8217;s disease of bone (also known as osteitis deformans) is a nonmalignant disease involving accelerated bone resorption followed by deposition of dense, chaotic, and ineffectively mineralized bone matrix.<br \/>\n<!--more--><br \/>\nAn estimated 70% of patients who have Paget&#8217;s disease have no symptoms. The diagnosis is typically found incidentally on radiographs and laboratory investigations. Clinical manifestations, when present, may be wide in spectrum.<\/p>\n<p><strong>Symptoms of Paget&#8217;s Disease<\/strong><\/p>\n<ul>\n<li>Bone pain from microfractures or osteoarthritis; if the jaw is involved, teeth may become loose<\/li>\n<li>Headaches and loss of hearing or vision from pressure on nerves, brain, or spinal cord and reduced blood flow<\/li>\n<li>Pain or neuropathy from pressure on nerves<\/li>\n<li>Increased head size, bowing of a limb, or curvature of the spine<\/li>\n<li>Hip pain<\/li>\n<li>Damage to cartilage of joints, which may lead to osteoarthritis<\/li>\n<li>Heart failure (only in severe cases, especially in patients with heart disease)<\/li>\n<li>Kidney stones (more common in patients with Paget&#8217;s disease)<\/li>\n<li>Sarcoma, in less than 1% of patients with Paget&#8217;s disease<\/li>\n<\/ul>\n<p>Patients with bone pain caused by Paget&#8217;s disease usually describe the pain as continuous. Unlike osteoarthritis, pagetic bone pain usually increases with rest, on weight bearing, when the limbs are warmed, and at night. Paget&#8217;s disease can cause osteoarthritis if the affected section of bone is near a joint.<br \/>\nA variety of deformities may occur, including kyphosis; shortened or bowed limbs; leonine facies; frontal bossing of the forehead; dental abnormalities; and, in severe cases, an enlarged cranium that may be difficult to hold erect.<\/p>\n<p><strong>Biochemical Markers<\/strong><br \/>\nThere are many biochemical markers for Paget&#8217;s disease, but the two most important are total serum alkaline phosphatase and urinary pyridinoline. These markers may be normal in patients with the monostotic form of Paget&#8217;s disease (15% of patients) therefore, serum bone-specific alkaline phosphatase measurements may be useful. Urinary hydroxyproline is no longer considered an accurate marker of activity or extent of the disease.<\/p>\n<p><strong>Radiography<\/strong><br \/>\nRadiographs include both lytic (early) and sclerotic findings. Many patients are diagnosed incidentally in the asymptomatic phase by plain radiographs that show localized enlargement of bone. These radiographs often have a high specificity because of their classic nature, but a low sensitivity. Bone scans can be used to increase the sensitivity in patients suspected of having Paget&#8217;s disease; however, the bone scan is less specific and should be interpreted cautiously. Once a diagnosis of Paget&#8217;s disease is confirmed, repeat radiographs are required only to monitor degeneration around weight-bearing joints. Computed tomography and magnetic resonance imaging are not necessary.<\/p>\n<p><strong>Radiologic Findings in Patients with Paget&#8217;s Disease<\/strong><\/p>\n<p><strong>Radiographic<\/strong><\/p>\n<ul>\n<li>Osteoporosis circumscripta in skull<\/li>\n<li>Flame-shaped lesions in long bones<\/li>\n<li>Osteolytic lesions near thickened lesions<\/li>\n<li>Sclerotic bone<\/li>\n<li>Bowed limbs<\/li>\n<li>Fractures, including \u201cbanana\u201d or \u201cchalk\u201d transverse fractures<\/li>\n<\/ul>\n<p><strong>Bone scintigraphy<\/strong><\/p>\n<ul>\n<li>Areas of increased uptake of technetium-99m<\/li>\n<li>\u201cMouse face\u201d pattern on scan of affected vertebra<\/li>\n<\/ul>\n<p>If the results of the biochemical markers and radiography are inconclusive, a biopsy of the affected bone may be indicated in rare cases.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li><span style=\"line-height: 1.3em;\">Schneider D, Hofmann MT, Peterson JA. Diagnosis and treatment of Paget&#8217;s disease of bone. Am Fam Physician. 2002 May 15;65(10):2069-72. <\/span><a style=\"line-height: 1.3em;\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/12046775\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li><span style=\"line-height: 1.3em;\">Whyte MP. Clinical practice. Paget&#8217;s disease of bone. N Engl J Med. 2006 Aug 10;355(6):593-600. <\/span><a style=\"line-height: 1.3em;\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/16899779\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li><span style=\"line-height: 1.3em;\">Ralston SH. Clinical practice. Paget&#8217;s disease of bone. N Engl J Med. 2013 Feb 14;368(7):644-50. <\/span><a style=\"line-height: 1.3em;\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/23406029\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created Feb 20, 2013.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[153],"tags":[1115,123,13,51,50,1113,2003],"class_list":["post-5590","post","type-post","status-publish","format-standard","hentry","category-endocrinology-and-metabolism","tag-bone","tag-diagnosis","tag-diagnostico","tag-disease","tag-enfermedad","tag-hueso","tag-paget"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/5590","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=5590"}],"version-history":[{"count":4,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/5590\/revisions"}],"predecessor-version":[{"id":9309,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/5590\/revisions\/9309"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=5590"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=5590"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=5590"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}