iatroX Rounds #28
The clues
- 1
A 72-year-old man presents with deep, boring pain in his right hip and thigh that has been gradually worsening over the last six months.
- 2
The pain is often worse at rest and at night, and he has noticed his right leg seems to be curving outwards.
- 3
His wife mentions that he has become increasingly hard of hearing lately and frequently asks for the television volume to be turned up.
- 4
On examination, the right femur and tibia appear bowed, and the skin overlying the right shin feels noticeably warmer than the left.
- 5
Laboratory investigations reveal a significantly elevated serum alkaline phosphatase of 650 U/L, while serum calcium, phosphate, and parathyroid hormone levels are all within normal limits.
- 6
An X-ray of the pelvis and femur shows marked cortical thickening, expansion of the bone, and a pattern of coarse, disorganised trabeculae.
Paget's disease of bone is a localised disorder of bone remodelling characterised by excessive bone resorption followed by disorganised and excessive bone formation. It typically affects older adults and most commonly involves the pelvis, femur, skull, and spine.
- Isolated elevation of alkaline phosphatase (ALP) with normal calcium and phosphate
- Bone pain and skeletal deformity such as bowing of the long bones
- Neurological complications including sensorineural hearing loss due to cranial nerve compression
- Increased local skin temperature over affected bones due to hypervascularity
for education and entertainment. not medical advice.