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Paget Disease of Bone — RACP Adult Medicine MCQ

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EasyEndocrinologyPaget Disease of BoneRACP Adult Medicine

A 70-year-old man presents with bone pain in the lumbar spine. ALP is 850 U/L with normal calcium, phosphate, and PTH. Other LFTs and GGT are normal. X-ray shows expanded pagetic bone with mixed lytic and sclerotic areas and cortical thickening. Isotope bone scan shows increased uptake in L3–L5. What is the most likely diagnosis?

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Correct answer: E — Paget disease of bone

Markedly elevated ALP with normal calcium and phosphate, expanded bone with mixed lytic/sclerotic changes and cortical thickening is diagnostic of Paget disease. The isolated ALP elevation (with normal GGT confirming bone origin) is characteristic. Treatment is a single IV dose of zoledronic acid (5 mg), which can produce long-lasting remission. Indications include bone pain, risk of fracture, or planned surgery.

Reference: Endocrine Society – 2022 – Paget Disease Guidelines; ESA 2024