Bone biopsy

It is relatively rare for a tissue sample of the bone (bone biopsy) to be taken. This diagnostic method is only necessary if, after CT and MRI examinations, bone metastases or Paget’s sarcoma are still suspected. The latter is a malignant bone tumor (osteosarcoma), which develops from degenerated osteoblasts in one percent of patients as a result of Paget’s disease.

Laboratory test

As with all other forms of the disease, Paget’s disease of the skull can be characterized by an increase in the enzyme alkaline phosphatase (AP) or bone-specific alkaline phosphatase (ALP) in the blood and an increase in hydroxyproline in the urine. These laboratory values are an important part of diagnostics and can be used to monitor the progress of a therapy.

Therapy of the Mobus Paget

The primary goals of Paget’s disease therapy are to eliminate the pain and, in addition, to stop the progressive deformations (bone deformation) and inhibit the osteoclasts. Paget’s disease therapy is not always necessary. A patient with an asymptomatic course of Paget’s disease, in whom no deformities have been detected, usually does not require therapy. According to Ziegler, the indication for therapy of Paget’s disease can be divided into three different stages

Absolute indication for therapy Strong remodelling activities with an AP > 600 IEl Bone pain Deformities (bone deformation)High risk of fracture (risk of bone fracture)Failure of adjacent nerve structures Attacking the base of the skull
Strong conversion activities with an AP > 600 IEl
Bone Pain
Deformities (bone deformation)
High risk of fracture (risk of bone fracture)
Failure of adjacent nerve structures
Infestation of the skull base
Relative indication for therapy Mean disease activity Feeling of warmth Infection of the skull calotte Preparing for surgical therapy measures Heart failure (weakness of the heart)
Average disease activity
Feeling of warmth
Infestation of the skull calotte
Preparing for operative therapy measures
Heart failure (cardiac insufficiency)
No definite indication for therapy Patient is over 75 years of age No symptoms
Patient is older than 75 years
No symptoms
Reduced conversion activities
Only a few bones are affected
Strong conversion activities with an AP > 600 IEl
Bone Pain
Deformities (bone deformation)
High risk of fracture (risk of bone fracture)
Failure of adjacent nerve structures
Infestation of the skull base
Average disease activity
Feeling of warmth
Infestation of the skull calotte
Preparing for operative therapy measures
Heart failure (cardiac insufficiency)
Patient is older than 75 years
No symptoms
Reduced conversion activities
Only a few bones are affected

The following individual forms of therapy for Paget’s disease can be recorded:

Pain relief through anti-inflammatory and analgesic drugs
Kalcitonin – therapy (self-injection of the hormone; nasal spray) to reduce osteoclast activity100 E for one month, then 300 E for another 6 months
Bisphosphonates (e.g. Fosamax -> not approved for the treatment of Paget’s disease) to inhibit increased bone resorption
Pain therapy and/or physiotherapy to support drug therapy
Surgical therapy (joint replacement operations, repositioning osteomies)