Endocrinology

Front 1

Indications for medical management of Pagets disease

Back 1

complications of Paget disease, including bone pain, progressive skeletal deformity, high-output congestive heart failure, hypercalcemia, compression of spinal cord and nerve roots, bone compression of the eighth cranial or optic nerve, recurrent renal calculi due to hypercalciuria, or fractures. When Paget disease occurs around a joint, treatment is often administered in an attempt to prevent development of osteoarthritis

Front 2

Management of Pagets disease

Back 2

Medical therapy for Paget disease should include bisphosphonate treatment with serial monitoring of bone markers. Bone markers should be rechecked 2-3 months following bisphosphonate treatment.
Because of the increased risk of malignancy, patients with Paget disease should be monitored indefinitely.
Nonsteroidal anti-inflammatory drugs and acetaminophen may be effective for pain management.
Orthotic devices, including canes and walkers, may be useful for patients with Paget disease that involves the lower limbs who have gait abnormalities.
Chemotherapy, radiation, or both may be used to treat neoplasms that arise from pagetic bone.

Hint 2

Nitrogen containing bisphosphonates

Front 3

How do you monitor sucess of treatment in Pagets?

Back 3

Periodic monitoring of ALP

Front 4

Pagets treatment in asymptomatic disease

Back 4

Active disease (as determined on bone scan/ALP) and if disease is present at sites were complications could occcur (skull, spine, weight bearing bones, abutting joint lines)

Front 5

Side effects of bisphosphonates

Back 5

Acute phase respinse for a few days- treat with paracetamol/nsaids
muskuloskeletal pain

Front 6

Adjunct to bisphosphonate treatment of pagets?

Back 6

oral calcium + vit D to avoid hypocalcemia
assure normal Ca + vit D levels before beginning treatment
Invasive dental work before start treatment if possible to avoid the minor risk of osteonecrosis of the jaw

Front 7

Epidemiology of pagets

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3-4% >40
m=f
14-25% of family members get it
Latent viral infection of osteoclasts in a genetically susceptible person

Front 8

Histology of Pagets

Back 8

initially osteolysis followed by osteosclerosis
Usually all phases are seen simultaneously at multiple foci in a given patient

Front 9

Most common clinical manifestations of pagets

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pain and deformity in a given area

fractures, bone tumors, neurologic disease, cardiac disease, and abnormalities in calcium and phosphate balance can also occur. In addition, because of the vascularity of pagetic bone, excessive bleeding may occur during orthopaedic surgery

Front 10

Bone pain of Pagets

Back 10

often worstens upon weight bearing and may increase at night