The clinical relevance of radiologically revealed Paget's disease of bone (osteitis deformans)

Abstract

Radiological and hospital records of 400 patients with Paget's disease that was shown radiologically have been examined in an effort to establish the clinical significance of the disease. Twenty‐eight per cent of the patients were considered to have symptoms related to their disease, the most frequent symptom being bone pain, deformity and fracture. It appears that Paget's disease may predispose to the formation of urinary calculi. Malignant change and neurological and cardiovascular complications are rare, and osteitis deformans does not appear to predispose to osteoarthrosis.

Paget's Disease of Bone

“…Radiographically, the tumors may be lytic, sclerotic, or mixed; disruption of the cortex is an important clue to diagnosis 25 . Bone scans and bone biopsy can be helpful in diagnosis 13,14 . The high incidence of pathologic fracture through the tumor site, or a rapid rise in the serum alkaline phosphatase level (both claimed to be common in earlier reports) were not confirmed in the report on the largest series of these patients 25 .…”

“…Symptoms occur in approximately 20–40 per cent of patients who have lesions detected in radiographs 12,14 . Symptoms are more common when the serum alkaline phosphatase level is higher than 500 IU/L, but a patient who has a single osteolytic lesion in a limb or extensive sclerotic disease and small fissure fractures along the convexity of a long bone may experience considerable pain even though the serum alkaline phosphatase level is not unusually high.…”

Paget's Disease of Bone in Older Patients UCLA Grand Rounds

“…It is generally acknowledged that most patients with Paget's disease are asymptomatic, 23 though the reported prevalence of symptoms ranges from 25% 24 to 88%–94% of subjects 25 , 26 depending on the population studied. In many instances, the disease is discovered coincidentally on x‐rays or by elevated serum alkaline phosphatase.…”

Paget's disease and osteoarthritis

“…Choree fibrillaire de Morvan, which was related to gold toxicity by Chavany and Chaignot (9) as early as 1934, is most often associated with peripheral neuropathy (2). Morvan's "choree" has been attributed to gold-induced alteration of the anterior horn cell and metal deposits in spinal ganglia (1).…”