What is Paget's Disease?

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Paget’s disease
Paget’s disease (PD), also known as osteitis deformans, is considered to be an osteometabolic disorder. It can be described as a focal disorder of accelerated and disorganized skeletal remodeling that may affect multiple bones in the body, giving rise to progressive enlargement and deformity of the bones and joints.1 PD is prevalent across both the sexes with incidence ranging from 1.5% to 8%.2 It is more common in individuals over 50 years of age.

Pathology
PD is described by a confined, disproportionate, and uncontrolled osteoclastic bone resorption. This results in subsequent compensatory augmented osteoblastic activity, ultimately resulting in an unstable, unstructured fibroblastic and biomechanical less stable bone.3 However, the precise pathophysiology of PDB still remains to be established. It is believed that PD may result from genetic alterations that could account for its presence in multiple family members.4 Other studies also hypothesize that paramyxovirus infection is the etiologic agent of the disorder.5
The disease process consists of the following three phases:
Phase I: An osteolytic phase characterized by noticeable and significant bone resorption and hyper vascularization.
Phase II: A sclerotic phase, which indicates a previous increase in bone formation but currently decreased cellular activity and vascularity.
Phase III: A phase comprising a mixture of both, active bone resorption, which is compensated by bone formation. This phase is characterized by a disordered skeletal structure, making the bone sponge-like, weak, and deformed.1
A typical course of Paget's disease is often asymptomatic. However, the clinical presentation of a symptomatic patient differs significantly. T...

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...f bone. J of Bone Miner R. 13(7):1061-10.
6) Josse RG, Hanley DA, Kendler D, et al. Diagnosis and treatment of Paget’s disease of bone. Clin Invest Med. 2007; 30(5): E210-E223.
7) Singer FR. Evolution of the clinical presentation of Paget’s disease of bone. Clin Rev Bone Miner Metab. 2002; 1(2): 95-98.
8) Roux C, Dougados M. Treatment of patients with Paget’s disease of Bone. Drugs. 1999 Nov; 58 (5): 823-830.
9) Selby PL, Davie MWJ, Ralston H, et al. Guidelines on the management of Paget’s disease of bone. Bone. 2002; 31: 10-9.
10) Patel S, Pearson D, Hosking DJ. Quantitative bone scintigraphy in the management of monostotic Paget’s disease of bone. Arthritis Rheum. 1995; 38: 1506-12.
11) Drake WM, Kendler DL, Brown JP. Consensus statement on the modern therapy of Paget’s disease of bone from a Western Osteoporosis Alliance Symposium. Clin Ther. 2001; 23: 620-6.

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