Paget’s Disease USMLE Notes

Paget’s Disease USMLE Notes & Mnemonics contains all the high-yield points you need to know.

• Definition: A chronic disorder characterized by excessive breakdown and formation of bone, leading to bone enlargement and deformity.
• Etiology: Unknown, possibly viral (paramyxovirus) or genetic factors.

Pathophysiology

• Imbalance in osteoclast and osteoblast activity.
• Initially increased bone resorption followed by excessive bone formation. (ref)
• New bone is larger but weaker and disorganized (mosaic pattern).

Epidemiology

• More common in >55 years old.
• Slight male predominance.

Clinical Features

• Often asymptomatic, found incidentally on X-ray or labs.
• Bone pain and deformity.
• Enlarged skull, hearing loss (due to auditory foramen enlargement).
• Increased hat size.
• Warm skin over affected bones (increased vascularity).

Diagnosis

• X-Ray: Enlarged bones with mixed lytic and sclerotic areas, “cotton-wool” appearance of the skull.
• Lab Tests: Elevated alkaline phosphatase (ALP), normal calcium, and phosphate.
• Bone Scan: Increased uptake in affected areas.

Treatment

• Bisphosphonates: First-line (e.g., alendronate, zoledronic acid) – reduce bone turnover.
• Calcitonin: Second-line, less effective than bisphosphonates.
• Pain Management: NSAIDs or acetaminophen for symptomatic relief.

Complications

• Osteoarthritis (due to abnormal bone structure).
• Fractures (due to weak bone).
• High-output cardiac failure (rare, due to increased vascularity).
• Osteosarcoma (rare but serious complication).

Paget’s Disease USMLE Mnemonic: “PAGETS“

• Paramyxovirus (possible etiology)
• Alkaline phosphatase elevated
• Giant osteoclasts (pathology)
• Enlarged skull
• Thickened, disorganized bones
• Secondary osteosarcoma risk

Check other important USMLE Notes

Note: For USMLE, focus on recognizing the clinical presentation, characteristic radiographic findings, and the importance of alkaline phosphatase in diagnosis. Understanding the first-line treatment and potential complications, especially the rare transformation to osteosarcoma, is crucial.

• There is no specific diet recommended for patients with Paget disease of the bone
• Patients prescribed bisphosphonates should ensure adequate intake of calcium and vitamin D
• Aggressive physical activity is not advised due to the high risk of fractures
• Gentle muscle-strengthening exercises at a moderate intensity are recommended

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