LATE SCLEROTIC PHASE DIAGNOSIS OF PAGET'S DISEASE OF BONE: A CASE REPORT
DOI:
https://doi.org/10.53555/gwmgqm81Keywords:
Bone resorption, MRI imaging, Paget's disease of bone, Serum alkaline phosphatase, Zoledronic acidAbstract
Background: Paget’s disease of bone (PDB), is a chronic skeletal disorder marked by abnormal bone remodeling due to increased osteoclastic activity followed by disorganized osteoblastic bone formation. It commonly affects older adults and present with pain, deformities, or fractures.
Methods: A 64-year-old male with Parkinsonism and hypertension, who reported chronic low back and groin pain. Laboratory evaluation revealed markedly elevated serum alkaline phosphatase (422.2 U/L), and MRI imaging showed suggestive of PDB in the late sclerotic phase.
Results: A single intravenous dose of zoledronic acid (5 mg) was administered, resulting in symptom relief and planned biochemical follow-up. Calcium and vitamin D supplementation were initiated to prevent treatment-related complications.
Conclusion: A multidisciplinary team involving physicians, clinical pharmacists, and nurses was critical in ensuring optimal care, preventing complications, and improving patient outcomes and quality of life.
References
1. Karunarathna, I., Bandar, S., Godage, S., Senadeera, S., Wijepala, J., Rodrigo, P. N., ... & Ranwala, R. Paget Disease of Bone: A Comprehensive Review of Pathogenesis, Diagnosis, and Management.
2. da Costa, R. P., Lopes, A. R., Matos, C. O., Travessa, A., Dias, P., Martins, P., ... & Romeu, J. C. (2025). POS1239 PAGET'S DISEASE OF BONE: CLINICAL AND EPIDEMIOLOGICAL PROFILING OF A PORTUGUESE COHORT AT A TERTIARY CENTER. Annals of the Rheumatic Diseases, 84, 1294-1295.
3. Karunakaran, K., Murugesan, P., Rajeshwar, G., & Babu, S. (2012). Paget's disease of the mandible. Journal of oral and maxillofacial pathology, 16(1), 107-109.
4. Nebot Valenzuela, E., & Pietschmann, P. (2017). Epidemiology and pathology of Paget’s disease of bone–a review. Wiener Medizinische Wochenschrift, 167(1), 2-8.
5. Cook, S. J., & Wall, C. (2021). Paget's disease of bone: A clinical update. Australian journal of general practice, 50(1/2), 23-29.
6. van Staa TP, Selby P, Leufkens HG, Lyles K, Sprafka JM, Cooper C. Incidence and natural history of Paget's disease of bone in England and Wales. J Bone Miner Res. 2002;17(3):465–71.
7. Kravets, I. (2018). Paget's disease of bone: diagnosis and treatment. The American journal of medicine, 131(11), 1298-1303.
8. Khan, I. A., & Bordoni, B. (2023). Histology, osteoclasts. In StatPearls [Internet]. StatPearls Publishing.
9. Aransiola, C. O., & Ipadeola, A. (2016). Asymptomatic Paget's disease of bone in a 62-year-old Nigerian man: three years post-alendronate therapy. Endocrinology, Diabetes & Metabolism Case Reports, 2016(1).
10. Sofaer, J. A., Holloway, S. M., & Emery, A. E. (1983). A family study of Paget's disease of bone. Journal of Epidemiology & Community Health, 37(3), 226-231.
11. Guañabens, N., Filella, X., Florez, H., Ruiz-Gaspá, S., Conesa, A., Peris, P., ... & Torres, F. (2019). Tartrate-resistant acid phosphatase 5b, but not periostin, is useful for assessing Paget's disease of bone. Bone, 124, 132-136.
12. Shaw, B., Burrell, C. L., Green, D., Navarro-Martinez, A., Scott, D., Daroszewska, A., ... & Layfield, R. (2019). Molecular insights into an ancient form of Paget’s disease of bone. Proceedings of the National Academy of Sciences, 116(21), 10463-10472.
13. Hsu, E. (2019). Paget's disease of bone: updates for clinicians. Current Opinion in Endocrinology, Diabetes and Obesity, 26(6), 329-334.
14. Swetha, S., Rao, G. N., Mahalakshmi, V., & Sathya, R. (2025). Alkaline phosphatase and acid phosphatase in health and disease–A systematic review. Journal of Oral and Maxillofacial Pathology, 29(2), 324-334.
15. Muschitz, C., Feichtinger, X., Haschka, J., & Kocijan, R. (2017). Diagnose und Behandlung der Knochenerkrankung Morbus Paget: Eine klinische Praxisstudie. Wiener Medizinische Wochenschrift, 167, 18-24.
16. Polyzos, S. A., Anastasilakis, A. D., Makras, P., & Terpos, E. (2011). Paget’s disease of bone and calcium homeostasis: focus on bisphosphonate treatment. Experimental and clinical endocrinology & diabetes, 119(09), 519-52
