Paget's disease Osteitis Defromans

• Facts:
  Abnormal bone remodeling
  Increased rate of bone turnover (osteoclast hyperfunction)
• History / PE:
  Hearing loss in 30-40% of pts
  H/O hats, rings no longer fitting
  Bone pain
• Diagnosis:
  Elevated alkaline phosphatase , urinary hydroxyproline
  Normal calcium and phosphate levels
  Radionuclide bone scan
  Femoral bowing
• Treatment:
  No treatment if asymptomatic
  Bisphosphonates and calcitonin (prevent bone resorption)
  NSAIDs and acetaminophen (arthritis pain)
• Complications:
  High output cardiac failure
• Differential Diagnosis:
  Acromegaly