Paget's disease is a common disorder of the skeleton that is local in nature and extremely variable in its clinical manifestations. When symptoms are present, skeletal deformity and pain are most common. Deformities are usually most apparent in the skull, face, and lower extremities. Pain is of several origins. Localized bone pain is surprisingly uncommon, but joint pain is seen not infrequently owing to degenerative arthritis. Pain of neural or spinal origin is unusual but the most severe. The diagnosis of Paget's disease is primarily accomplished by roentgenographic evaluation of the skeleton. The initial stage of the disease is represented by a localized area of reduced bone density often referred to as an osteolytic lesion. In the most advanced stage of Paget's disease, the areas of previous osteolytic dominance are characterized by a chaotic sclerotic appearance, a phase that is called osteoblastic or osteosclerotic. Bone scans are the most sensitive means of detecting pagetic lesions. Radiolabeled bisphosphonates accumulate in regions where blood flow and bone formation are increased and can outline early lesions that are not detectable on roentgenograms. Radioactive gallium can also define areas of Paget's disease activity because of uptake of gallium by osteoclasts. Understanding the pathophysiology of Paget's disease should provide important insights into the mechanisms that control normal osteoclast differentiation and bone formation and may lead to new therapies for both patients with Paget's disease and the identification of new anabolic factors for treating patients with severe bone loss.
|Original language||English (US)|
|Title of host publication||Principles of Bone Biology, Two-Volume Set|
|Number of pages||11|
|State||Published - Dec 1 2008|
ASJC Scopus subject areas
- Biochemistry, Genetics and Molecular Biology(all)