Excess osteoclastic activity → Excess bone resorption → Compensatory excess increase in osteoblastic activity → Increase in bone formation → Ultimately leading to disorganized woven bone formation → Increased susceptibility to fracture.
MC site of involvement in Paget’s: Pelvis
- Osteoporosis circumscripta/ Cotton wool skull: Caused by irregular areas of sclerosis
- Tam-o-Shanter skull: Excessive thickening of outer table of skull + Frontal prominence
- Picture frame vertebra
- Blade of grass sign/ Flame sign/ Advancing wedge sign
- Brim sign: Thick and sclerotic iliopectineal line
- Gold standard investigation/ IOC: Bone biopsy
- Finding on bone biopsy: Mosaic pattern = Excess (resorption + formation)
- DOC: Bisphosphonate
- DOC for pain relief: Calcitonin nasal spray.
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