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Paget Disease ALP — RACP Adult Medicine MCQ

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EasyEndocrinologyPaget Disease ALPRACP Adult Medicine

A 70-year-old man presents with bone pain in his left tibia. ALP is 850 U/L. GGT is normal (confirming bone origin). Calcium, phosphate, and PTH are normal. X-ray shows expanded cortical thickening, mixed lytic/sclerotic changes, and bowing of the left tibia. Isotope bone scan shows intense focal uptake in the left tibia. What is the most likely diagnosis?

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Correct answer: E — Bone disease (Paget)

Markedly elevated ALP with normal GGT (confirming bone origin), normal calcium/phosphate/PTH, and X-ray showing expanded pagetic bone with mixed lytic/sclerotic changes and cortical thickening is Paget disease of bone. Treatment: IV zoledronic acid (5 mg single dose) — can produce long-lasting remission. Indications: bone pain, risk of complications (fracture, deformity, nerve compression), planned surgery.

Reference: Endocrine Society – 2022 – Paget Disease; ANZBMS 2024