ABSTRACT
D – Raised alkaline phosphatase and normal calcium is patient has presented with features of Paget bone disease (also known as osteitis deformans). Paget disease is a disorder of bone remodelling, characterized by excessive bone reabsorption by osteoclasis, followed by a compensatory increase in bone formation by osteoblasts. is new bone, however, is structurally weaker and more vascular than normal bone, leading to deformity, increased susceptibility to fractures and high output cardiac failure. It most commonly aects people from the age of 50 upwards and is more common in males. Paget disease most commonly aects the skull, spine, pelvis and legs. e alkaline phosphatase is always raised. Calcium, phosphate, alanine transferase and parathyroid levels are normal, except in the setting of prolonged immobility, where hypercalcaemia may ensue. Characteristic appearances are found on X-ray; the bone cortex appears spongy, there is marked coarsening of the trabeculae and the whole bone is thickened. Treatment is largely with bisphosphonates, which inhibit bone reabsorption. Complications of Paget disease include pathological fractures, compression of cranial nerves within an enlarging skull, and the development of osteosarcomas.
