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Paget disease of bone — SCE Rheumatology MCQ

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EasyMetabolic bone diseasePaget disease of boneSCE Rheumatology

A 52-year-old man has skull enlargement and deep aching tibial pain. Examination shows the tibia is bowed and warm. Investigations show alkaline phosphatase is raised with normal calcium. The diagnosis is established and symptoms remain clinically important despite initial supportive measures. There is no contraindication to disease-modifying or anti-inflammatory escalation. What is the most appropriate management?

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Correct answer: C — Zoledronic acid infusion

Zoledronic acid infusion is the best answer because zoledronic acid infusion is the most appropriate next step for paget disease of bone in this clinical setting. Oral bisphosphonate therapy is a plausible distractor, but it does not account for the key discriminator in the stem. Increase NSAID therapy and Urgent antibiotics would be more appropriate in a different clinical pattern or at another point in the pathway, while Stop causative glucocorticoid if feasible is suboptimal for this presentation. Clinical pearl: rheumatology management is generally treat-to-target, but infection risk, pregnancy plans and shared-care monitoring often determine the safest answer.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions