Paget disease: The Daily PANCE Blueprint
A 69-year-old male presents with chronic bone pain and progressive hearing loss. Labs demonstrate a normal calcium and phosphate, but markedly elevated alkaline phosphatase. Imaging reveals a "cotton wool" appearance of the skull. Which of the following is the most appropriate first-line treatment?
A. Vitamin D supplementation
B. Calcitonin
C. Systemic steroids
D. Parathyroidectomy
E. Bisphosphonates
Answer and topic summary
The answer is E. Bisphosphonates
Paget disease is a progressive skeletal disease defined by increased bone turnover and weakened bones. It is common in people older than 55 years old. It is caused by RANKL-RANK receptor activation. Clinical features include bone pain, pathological fractures, skull enlargement, impaired hearing, bowing of legs, and headaches. Some people are asymptomatic. Workup can include: calcium, PTH, ALP, and phosphate levels, plus x-rays. Some x-ray findings include sclerotic and osteolytic lesions, thickened cortical bone, and the cotton wool appearance of the skull. 1st line is bisphosphonates; the second line is calcitonin.
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Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ ⇒
Also covered as part of the Internal Medicine EOR topic lists
