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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