Bone disease

Disease Features Treatment

Pagets ∑ Focal bone resorption followed by excessive and Bisphosphonates
chaotic bone deposition
∑ Affects (in order): spine, skull, pelvis and femur
∑ Serum alkaline phosphatase raised (other
parameters normal)
∑ Abnormal thickened, sclerotic bone on x-rays
∑ Risk of cardiac failure with >15% bony
involvement
∑ Small risk of sarcomatous change
Osteoporosis ∑ Excessive bone resorption resulting in Bisphosphonates, calcium and
demineralised bone vitamin D
∑ Commoner in old age
∑ Increased risk of pathological fracture, otherwise
asymptomatic
∑ Alkaline phosphatase normal, calcium normal
Secondary bone ∑ Bone destruction and tumour infiltration Radiotherapy, prophylactic fixation
tumours ∑ Mirel scoring used to predict risk of fracture and analgesia
∑ Appearances depend on primary (e.g.sclerotic -
prostate, lytic - breast)
∑ Elevated serum calcium and alkaline
phosphatase may be seen

1 3/3 74-76 of 81
Theme: Bone disease

A. Osteogenesis imperfecta
B. Osteoporosis
C. Rickets
D. Pagets disease
E. Chondrosarcoma
F. Metastatic breast cancer

Please select the most likely diagnosis for the scenario given.
74. A 66 year old lady presents with pain in her right hip. It has been increasing over the three weeks and waking
her from sleep. On examination she is tender on internal rotation. Blood tests reveal a mildly elevated serum
calcium and alkaline phosphatase levels.
Metastatic breast cancer
Increasing pain at rest, together with increased serum calcium and alkaline phosphatase are most likely to
represent metastatic tumour to bone. Chondrosarcomas do occur in the pelvis but are not associated with
increased serum calcium and typically have a longer history.

75. A 73 year old man presents with pain in the right leg. It is most uncomfortable on walking. On examination he
has a deformity of his right femur, which on x-ray is thickened and sclerotic. His serum alkaline phosphatase is
elevated, but calcium is within normal limits.
Pagets disease
This is a typical scenario for Pagets disease.

76. A 73 year old lady presents with pain in her left hip. She was walking around the house when she tripped over
a rug and fell over. Apart from temporal arteritis which is well controlled with prednisolone she is otherwise
well. On examination he leg is shorted and externally rotated.Her serum alkaline phosphatase and calcium are
normal.
Osteoporosis
The combination of age, female gender and steroids coupled with hip pain on minor trauma are strongly
suggestive of osteoporosis.