A 72-year-old man has unilateral skull pain and radiographic cortical thickening suspicious for monostotic Paget disease, but total ALP is normal.

Question

A 72-year-old man has unilateral skull pain and radiographic cortical thickening suspicious for monostotic Paget disease, but total ALP is normal. Which investigation best defines whether other bones are involved?

Accepted Answer

Radionuclide bone scintigraphy with targeted radiographs of abnormal sites

Answer

Whole-body low-dose CT to quantify activity at every affected skeletal site

Answer

Bone biopsy from each scintigraphically active site before treatment decisions

Answer

Serial total ALP measurements until biochemical activity becomes detectable

Answer

DXA of the lumbar spine and hips to map the skeletal distribution

Paget's disease of bone — SCE Endocrinology MCQ

A 72-year-old man has unilateral skull pain and radiographic cortical thickening suspicious for monostotic Paget disease, but total ALP is normal. Which investigation best defines whether other bones are involved?