Pathologie (Fach) / Muskuloskeletal (Lektion)

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Common, localized disorder of bone remodeling caused by ↑ osteoclastic activity followed by ↑ osteoblastic activity that forms poor-quality bone.- Leads to deformities and potential fractures.- Second most prevalent skeletal disease after osteoporosis- Age of onset: >55 years

Localization: Skull, lumbar vertebrae, pelvis, femur

3 phases:1. Lytic phase: Osteoclasts aggressively demineralize the bone (20x more than normal)2. Mixed phase: Lytic + blastic phase.3. Sclerotic phase: New bone formation exceeds resorption → structurally disorganized and weaker bone4. Dormant state: "burned-out state"

Clinical features:- Approximately 70-90% of cases are asymptomatic. - Bone pain, which may be associated with erythema and elevated skin temperature over the affected bones- Bony deformities; e.g., bowing of legs (saber shin)- Skull involvement (in ∼ 40% of cases)→ Skull enlargement (increasing hat size)→ Cranial nerve deficits→ Impaired hearing→ Headache- Pathological fractures- May lead to osteosarcoma (= Paget sarcoma)

Diagnosis:- Normal calcium, phosphate, and parathyroid hormone (PTH) levels- ↑↑ Alkaline phosphatase- X-ray may shown lytic lesions (during lytic phase), thickened bone cortices (advanced)- Bone biopsy: Exclude malignancies

Treatment: Bisphosphonates

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