In this episode, we review Paget's disease of bone, a chronic skeletal disorder characterized by abnormal bone remodeling that leads to structurally weak, enlarged, and deformed bone. We discuss the underlying pathophysiology of accelerated bone turnover, common risk factors such as age over 50, family history, and European ancestry, and the bones most frequently affected—including the pelvis, spine, skull, femur, and tibia. The episode also highlights key diagnostic clues such as elevated alkaline phosphatase levels and characteristic radiographic findings like the "cotton wool" appearance on X-ray. Finally, we cover treatment strategies—including bisphosphonates as first-line therapy, supportive management, and potential complications such as fractures, hearing loss, and rare malignant transformation to osteosarcoma.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.
2. Rendina, D., Falchetti, A., Diacinti, D., Bertoldo, F., Merlotti, D., Giannini, S., Cianferotti, L., Girasole, G., Di Monaco, M., Gonnelli, S., Malavolta, N., Minisola, S., Vescini, F., Rossini, M., Frediani, B., Chiodini, I., Asciutti, F., & Gennari, L. (2024). Diagnosis and treatment of Paget's disease of bone: position paper from the Italian Society of Osteoporosis, Mineral Metabolism and Skeletal Diseases (SIOMMMS). Journal of endocrinological investigation, 47(6), 1335–1360. https://doi.org/10.1007/s40618-024-02318-1
3. Bouchette P, Boktor SW. Paget Bone Disease. [Updated 2023 Nov 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430805/