Osteitis deformans – Paget’s disease

Abnormal and anarchic resorption and deposition, resulting in distortion and weakening of the affected bones

Epidemiology: M > F, patients over 50 years, Max > Mand (2:1)


  • Slow paramyxovirus infection
  • Vascular disorder
  • AD


  • Fast, irregular, exaggerated bone remodelling
  • Thick bones without localized swelling
  • Early phase – resorption
  • Late stage – sclerosis
  • Patchy appearance due to areas of resorption and sclerosis adjacent to each other


  • Simian stance due to weakening of weight bearing bones,
  • Lion-like facial deformity (bilat symmetrical bone enlargement)
  • Pain on involved bones
  • Hypercementosis
  • Neurological symptoms due to narrowing of foramina:
    − Headache
    − Vertigo
    − Visual disturbance
    − Auditory disturbance

Complication: (0.9 – 13%): progression to osteosarcoma


  • Initial osteolytic – osteoclastic bone resorption
  • Mixed osteolytic/osteoblastic stage -mosaic pattern of reversal lines (osteoid seams)
  • Quiescent osteosclerotic stage – dense bone with remnants of mosaic patterns


  • “Cotton wool” appearance of confluent radio-opacities
  • Thickening of bone
  • Irregular areas of sclerosis and resorption
  • Loss of normal trabeculation


  • ↑alkaline phosphatase
  • Normal calcium and phosphorus levels
  • ↑ urinary hydroxyproline

Management: Seldom fatal

  • Surgical debulking + calcitonin (PTH antagonist) + sodium phosphatase (retards bone resorption)


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