Paget's Disease

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Paget's Disease of the Bone

• common
• enlargement and lytic lesions due to disordered bone remodelling
• excessive bone resorption results in lytic lesions followed by disorganised and excessive bone formation
• involves bones of axial skeleton
  • skull
  • spine
  • pelvis
  • + tibia
  • + proximal femur

Epidemiology

• generally affects >60 years old
• 3-4% manifest disease at autopsy

Pathology

• huge osteoclasts
  • >100 nuclei (normally <12)

Examination

• face
  • increased size of skull
  • hearing aid
• CNS
  • poor vision
  • optic atrophy
    • angioid streaks 
  • VIth nerve palsy
• Legs
  • inspection
    • unilateral anterior bowing of tibia
  • palpation
    • warm
  • auscultation
    • bruit

Complications

• bone pain / headache
• fractures
• poor mobility
• nerve or cord compression
• Hypercalcaemia
• sarcomatous change
• high output Heart Failure

Differential Diagnosis

• Syphilitic sabre tibia
• Rickets
  • usually bilateral

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