Paget's Disease: Skeletal Manifestations and Effect of Bisphosphonates

Abstract

BackgroundPaget's disease of bone leads to change in the shape and size of the bone and results in reduced bone strength, leading to the complications of deformity, arthritis, and fracture. Due to unknown reasons, Paget's disease is rare in Asian descendants. We report the cases of Paget's disease who visited our institute for 15 years and reviewed the literatures.MethodsWe retrospectively reviewed the medical records and radiograms of 8 patients (6 female and 2 male) who were diagnosed as Paget's disease of bone. Diagnosis was confirmed by typical radiological feature in the involved skeletons and/or pathologic findings.ResultsPelvis, skull and spine were three most frequently involved bones. All involved bones in our cases showed changes in shape and trabecular pattern which resulted in bowing of lower extremity, secondary osteoarthritis, compression fracture of spine and enlargement of skull. Mean follow time was 4.71 years and all patient were treated bisphosphonate (BP). Use of BP controlled the level of serum alkaline phosphatase level effectively.ConclusionsWe have reviewed eight patients who were previously diagnosed as Paget's disease of bone in our institute. We could identify typical radiologic and clinical findings such as bowing deformity of long bone, secondary osteoarthritis, compression fracture and osteomyelitis of mandible that deteriorated the quality of their living.

Stress Fracture of the Femoral Shaft in Paget’s Disease of Bone: A Case Report

“…In PDB, excessive over-activity of osteoblasts and osteoclasts might also result in the deposition of low-quality woven bone or area of osteolysis, resulting in deformity, secondary osteoarthritis and fracture. [ 20 ] It is presumed that stress fracture might occur in patients with PDB. [ 20 , 21 ] Although the exact etiology remains unclear, there are few possible explanations.…”

“…[ 20 ] It is presumed that stress fracture might occur in patients with PDB. [ 20 , 21 ] Although the exact etiology remains unclear, there are few possible explanations. First, bisphosphonate is a strong precipitating factor that is associated with a stress fracture.…”

Paget's Disease of Bone Affecting Peripheral Limb: Difficulties in Diagnosis: A Case Report

“…[1,2] In fact, only a few cases of PDB have been reported, and to date, no epidemiological studies have been reported in the Republic of Korea. [6][7][8] A positive family history is observed in approximately 15% to 30% of patients, and first-degree relatives of patients with PDB show an approximately 7-fold higher risk of PDB. Familial PDB is diagnosed in younger individuals and affects more multiple bony involvement than sporadic disease.…”

Paget's disease of bone revisited: The changing Indian scenario

“…Clinical findings range from an incidental radiological abnormality of “sclerotic-lytic” pattern of bones and an asymptomatic elevation of alkaline phosphatase to significant musculoskeletal symptoms such as bone pains, pathological fractures, macrocephaly, bony deformities, secondary osteoarthritis, compressive symptoms in the form of hearing and visual loss, vascular steal syndromes, a high-output heart failure, and osteosarcoma in <1% of affected patients. [ 7 ] A high index of suspicion is often needed to identify these clinical findings to make a diagnosis of Paget's disease. Treatment is indicated in symptomatic cases and in certain asymptomatic patients where biochemical parameters and radiological features indicate risk from untreated disease.…”