Paget disease of bone (PDB, or ostmonostotic or polyostotic skeletal disease. It is characterized by increased bone turnover, which causes normal lamellar bone to be replaced by weak woven bone. The cause of this common yet underdiagnosed skeletal disease is not known. It predominantly affects individuals over the age of 55 and is characterized by localized pain and bony deformities (such as bowing of long bones). Skeletal x-ray, bone scans, and serum alkaline phosphatase are important tests for diagnosing and monitoring the progression of PDB. Treatment is mainly supportive and involves the use of bisphosphonates to inhibit osteoclastic function.rmans) is a slowly progressive
Paget disease of the bone should not be confused with Paget disease of the nipple or , which are named after the same physician.
- Idiopathic disease
- Associated with a high rate of bone remodeling: ↑ RANKL-RANK activity → ↑ NF-κB signaling → ↑ osteoclast activity → ↑ osteoblast activity → formation of disorganized (woven) bone
Stages of Paget disease
Bone remodeling in Paget disease occurs in three phases, followed by a quiescent stage: 
- Lytic phase: ↑ number of osteoclasts appear in bone → ↑ osteoclastic activity → ↑ rate of bone resorption
- Mixed lytic and blastic phase: ↑ osteoclastic activity is accompanied by an ↑ number of osteoblasts, which infiltrate the lacunae: → ↑ rate of bone formation with haphazardly laid collagen fibers; → formation of abnormal hypervascular woven bone
- Sclerotic phase: Osteoblastic activity overtakes osteoclastic activity, which leads to formation of dense, sclerotic bone.
- Quiescent stage: Both osteoclastic and osteoblastic activity cease (“quiet phase” of the disease).
- Approximately 70–90% of cases are asymptomatic.
- Bone pain, which may be associated with erythema and elevated skin temperature over the affected bones
- Pathological fractures: chalk-stick fractures of long bones 
- Bony deformities, e.g., bowing of legs (saber shin)
- Skull involvement (in ∼ 40% of cases)
- Cauda equina syndrome, nerve root compression
- Blood work
Urinalysis: ↑ markers of collagen degradation 
- N-telopeptide, C-telopeptide
- See “ .”
- Deformed bones with both sclerotic and osteolytic lesions
Thickened cortical bone
- Coarsened trabeculae; expansion or enlargement of a region of the bone.
- Skull x-ray: thickening of the diploe; osteoporosis circumscripta (cotton wool appearance).
- Vertebral x-ray: thickening of the upper and lower plates of the vertebral body gives rise to a “picture frame” appearance; diffuse enlargement of the vertebrae (ivory vertebra)
- Pelvic x-ray: disruption/fusion of sacroiliac joints; thickened iliopectineal line (brim sign)
- Bone scans (skeletal scintigraphy): to test for additional bony lesions
Medical therapy 
- First-line: bisphosphonates
- Second-line: calcitonin therapy 
- Supportive therapy
Surgical therapy 
- Bone deformities
- Pathological fractures