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paget's disease
- 1. PAGET’S DISEASE Submitted by : Mukta kanbur 21NUG088 Submitted by Mukta S Kanabur 21NUG088
- 2. Introduction • Paget's disease is a chronic condition of bone characterized by disorder of the normal bone remodeling process. • Characterized by excessive breakdown of bone tissue followed by abnormal bone formation. • Also known as osteitis deformans is a bone disease unknown cause. • Affecting men twice as frequently as women. • Named after the England surgeons Sir James Paget.
- 3. Definition Paget’s disease of the bone is skeletal disorder resulting from excessive osteoclastic activity, affecting the long bone , pelvis, lumbar vertebrae and the skull predominantly.
- 4. Etiology • Idiopathic • Family history • Common in men than women. • Infection from blood borne viruses ,after acute viraemia, osteoclasts become chronically infected, stimulating osteoclastic proliferation.
- 5. Pathophysiology Primary proliferation of osteoclasts ⬇️ Bone resorption ⬇️ Osteoblastic activity ⬇️ Mosiac of disorganised pattern of bone develops ⬇️ Increased vascularity ⬇️ Pathologic fracture ⬇️ structural bowing of the legs causes malalignment of hip ,Knee and ankle joint . ⬇️ arthritis
- 8. Clinical manifestations • Pain and predisposition to fracture. • Pagetic lesions can lead to OA , joint destruction and spinal deformity • Impaired hearing as a result of skull enlargement • Tinnitus or vertigo • Rarely heart failure, hypertension, atherosclerosis and aortic valve calcification occur • Malignant bone tumour
- 9. Diagnostic evaluation • Elevated serum alkaline phosphatase • Serum calcium, phosphorus and albumin levels usually normal • Generally confirmed with radiologic examinations • Bone scans can evaluate pagetic activity • Bone biopsy
- 10. Management • No treatment for asymptomatic paget disease • Pain management; NSAIDS and aspirin • Medications: Calcitonin is the main medication used for this disease • Bisphosphonates : Etidronate disodium ( Didronel), alendronate(fosamax) pamidronate (aredia), risedronate(actonel) and an antineoplastic agent plicamycin(mithramycin) . • Tibial osteotomy done to realign knees and relieve pain.
- 11. Nursing management • Assessing pain and functional ability • Observing for bowing of legs or complaint that hats feel tight. • Assessing for cardiovascular complications • Assessing for auditory symptoms such as tinnitus,vertigo and hearing loss • Prevention of falls • Assisting patient with activities as necessary • Providing function and mobility aids such as heel lifts and walking aids as needed.
- 12. Health education • Teaching safety measures in the home, removal of loose rugs and obstacles to prevent falls and good lighting • Providing education about the disease process and medication treatment • Making sure that patient knows how to use mobility aids • Initating home care referral as indicated • Encouraging follow-up for periodic hearing tests and blood work.