Paget's
diseaseFeatures
- Bone pain - dull, boring
- Deafness
- Apathy
- Cardiac failure
- Osteosarcoma
Investigations
- Raised alk phos (reduces in 1/12 with Rx)
- Raised hydroxyproline (reduces in days with Rx)
- ?Bonescan
Indications for Rx
- Localised pain
- Neurological compression symptoms
- Osteolytic lesions in weight-bearing bones
- Prevention of #
Treatment
- Biphosphonates - etidronate 5mg/Kg for 6/12. Monitor alk phos and Ca (or pamidronate IV). Bone turnover is suppressed for several months, but symptoms often recur later. Bonescan 6/12 after treatment showing hot spots suggests that relapse will occur, despite low alk phos.
- Calcitonin - good for resistant bone pain but otherwise not often used.