Paget’s disease of bone/ Osteitis deformans

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Pathophysiology:

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

X-ray features:

  • 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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