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Paget
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> normal calcium and phosphate combined with a raised alkaline phosphate points to a diagnosis of Paget's Paget's disease of the bone Paget's disease is a disease of increased but uncontrolled bone turnover. It is thought to be primarily a disorder of osteoclasts, with excessive osteoclastic resorption followed by increased osteoblastic activity. Paget's disease is common (UK prevalence 5%) but symptomatic in only 1 in 20 patients Predisposing factors increasing age male sex northern latitude family history Clinical features - only 5% of patients are symptomatic bone pain (e.g. pelvis, lumbar spine, femur) classical, untreated features: bowing of tibia, bossing of skull raised alkaline phosphatase (ALP) - calcium* and phosphate are typically normal skull x-ray: thickened vault, osteoporosis circumscripta Indications for treatment include bone pain, skull or long bone deformity, fracture, periarticular Paget's bisphosphonate (either oral risedronate or IV zoledronate) calcitonin is less commonly used now Complications deafness (cranial nerve entrapment) bone sarcoma (1% if affected for > 10 years) fractures skull thickening high-output cardiac failure *usually normal in this condition but hypercalcaemia may occur with prolonged immobilisation
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