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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.


  • 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).


  • 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).


  • 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.


  • 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.


  • 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).
Pagets disease visual mnemonic
Pagets disease visual mnemonic

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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