Monday, 20 September 2010

MRCP revision battle 16.1: Pagets disease of bone

In between catching up on seemingly endless loads of washing (do socks breed when left alone in a wash basket?) a few hours of MRCP revision has been done and 7 new battles have been written...

MRCP revision battle 16.1: Pagets disease of bone
MRCP revision battle 16.2: Pneumocystis carinii
MRCP revision battle 16.3: Myasthenia gravis
MRCP revision battle 16.4: Lambert-Eaton syndrome
MRCP revision battle 16.5: Hemiballismus
MRCP revision battle 16.6: Prolactin
MRCP revision battle 16.7: Erbs palsy

MRCP revision battle 16.1: Pagets disease of bone

Pagets disease of bone is accelerated, disorganised bone turnover due to increased number and activity of osteoclasts and osteoblasts.

It is rare in under 40s.

Predisposing factors include:
  • increasing age
  • northern latitude
  • family history
  • being male

Features of Pagets include:
  • bone pain
  • bowing of tibia
  • bossing of skull
  • secondary arthritis
  • deafness/other cranial nerve compression
  • high output heart failure
  • pathological fractures
  • bone sarcomas (occur in 1% over 10 yrs)

My way of remembering the features of pagets is this slightly random rhyming story:
"Bowing to the Boss, oh what a pain,
I'm deaf and arthritic and since the fracture I'm lame
my heart's now a failure, and oh what a shame
I've got bone sarcoma - thats the end of the game"

Bloods in Pagets show:
  • raised ALP
  • normal calcium (unless a long period of immobility)
  • normal phosphate

Treatment is alendronic acid

That wasn't too bad... onwards to battle 16.2...