Paget disease: The Daily PANCE Blueprint

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Paget disease: The Daily PANCE Blueprint

An 80-year-old male with a history of hypertension presents to the clinic due to pain in his left leg for the past few months. He denies previous trauma. On exam, you note that the left tibia is bowing. Labs show elevated alkaline phosphatase and normal calcium levels. An x-ray demonstrates mixed sclerotic and lytic lesions of the left tibia. Which of the following is the most likely diagnosis?

A. Osteogenesis imperfecta
B. Osteoporosis
C. Rheumatoid arthritis
D. Paget’s disease
E. Chondrosarcoma

Answer and topic summary

The answer is D. Paget’s disease

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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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ Metabolic Disorders ⇒ Paget disease

Also covered as part of the Internal Medicine EOR topic lists

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