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Paget disease of bone — SCE Rheumatology MCQ

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ModerateMetabolic bone diseasePaget disease of boneSCE Rheumatology

A 68-year-old man has bone pain in the pelvis and increasing hat size. ALP is 620 IU/L, calcium and phosphate are normal and bone scan shows intense uptake in the skull and left hemipelvis. X-ray shows cortical thickening and coarse trabeculae. What is the most likely diagnosis?

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Correct answer: D — Paget disease of bone

Focal high bone turnover with raised ALP, normal calcium/phosphate, skull enlargement and coarse trabecular thickening is typical of Paget disease. Metastatic disease and myeloma are important differentials but the imaging and biochemistry are characteristic. Bisphosphonate therapy is considered for symptomatic active disease.

Reference: NICE CKS Paget disease; Endocrine Society Paget guideline