Paget’s disease of bone is a condition characterized by abnormal and anarchic resorption and deposition of bone, resulting in distortion and weakening of the affected bones

1. Paget’s Disease of Bone
(Osteitis Deformans)

2. What is Paget’s disease?
Paget’s disease of bone is a
condition characterized by
abnormal and anarchic resorption
and deposition of bone, resulting in
distortion and weakening of the
affected bones

3. Bone consists of
Osteoblasts: Bone forming cells
Osteoclasts: Bone breaking cells
Osteocytes: Present in the matrix
Matrix: Collagen, Calcium, Osteocalcin

4. Bone remodeling

5. Bones commonly affected

6. Clinical & Radiographic Features
Pain in or over a bone
Joint pain and limited mobility
The shape of the bone may change
-the bone in the legs may bend or bow out
-the bone in the skull may get bigger
Maxillary disease is more common than mandibular
Lionlike facial deformity (leontiasis ossea)
Patchy sclerotic areas of Skull RG (cotton wool)
Bone Scan of Mandible may show Codylar to
condylar uptake(Black beard or Lincoln’s sign)

7. Clinical & Radiographic Features
Bone breaks more easily
In late stages hipjoint may damage
Hearing problems may occur because the bone
expands and heart problems may also occur
COTTON WOOL APPEARANCE

8. Histopathological Features
Uncontrolled alternating resorption and formation of bone
Basophilic reversal lines- indicate the junction between
alternating resorptive and formative phases result in a
jigsaw puzzle, or mosaic appearance of the bone
REVERSAL LINES

9. NORMAL SKULL DISEASED SKULL
SKULL SIZE IN PAGETS DISEASE

10. What causes Paget’s disease
Unknown; evidence favors an infection of
genetically predisposed individuals with a
measles virus of the paramyxovirus family
Studies have demonstrated that abnormal virus-
infected osteoclasts generate IL-6, a resorptive
cytokine from the bone marrow of patients with
Paget’s disease

11. How common is Paget’s disease
The exact number of Paget’s disease is not known
Men are more likely to be affected than woman
 It usually affects people over the age of 40 years
It’s estimated to affect 3% of people over the age of
40

12. Epidemiology
Prevalence
High: United Kingdom, United States, Australia,
New Zealand, Western Europe
Low: Scandinavia, China, Japan, India
Family History: positive in as many as 40% of patients

13. Treatment
At this time there is no cure for Paget’s
disease. Therefore treatment is designed to
control the symptoms and change the rate of
bone growth.
When symptomatic, bone pain is noted most
frequently and often may be controlled by
acetaminophen or nonsteroidal antiinfl
ammatory drugs (NSAIDs).

14. Treatment
Biphosphonates
heplfull in rebuilding bone
Inhibits bone resorption and mineralisation
by promoting apoptosis of osteoclasts
for example Didronel, Fosamex and
Actonel

15. Treatment
Calcitonin (Parathrmone Antogonist)
Slows bone loss and bone growth
Gives relieve of bone pain
Reduces skin temperature over affected bone
sites
For example acetaminophen (Tylenol, Panadol)

16. Treatment
Surgery
1. Fractures: to allow fractures to heal in better
position
2. Bone deformity: cutting and realigning of the
affected bones
3. Severe degenerative arthritis: joint replacement of
the hips, knees