The following are the most important diseases or complications that may be contributed to by Paget’s disease: Cardiovascular system (I00-I99). Aortic valve stenosis – narrowing of a heart valve. Diffuse vascular calcifications Heart failure (cardiac insufficiency) Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93). Tooth loss, tooth damage Musculoskeletal system and connective tissue (M00-M99). Osteoarthritis … Paget’s Disease: Complications
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes; skull [enlargement of skull with raised forehead; platybasia (flattening of base of skull); changes in appearance of face; … Paget’s Disease: Examination
1st order laboratory parameters – obligatory laboratory tests. Serum alkaline phosphatase (bone AP) – the degree of increase correlates with the degree of symptomatology. Laboratory parameters 2nd order – depending on the results of the history, physical examination and obligatory laboratory parameters – for differential diagnostic clarification. Phosphate, calcium (serum and urine), parathyroid hormone (PTH), … Paget’s Disease: Test and Diagnosis
Therapy goals Pain relief Reduction of bone remodeling processes Therapy recommendations Analgesia (pain relief) according to WHO staging scheme: Non-opioid analgesic (paracetamol, first-line agent). Low-potency opioid analgesic (e.g., tramadol) + non-opioid analgesic. High-potency opioid analgesic (eg, morphine) + non-opioid analgesic. Antiresorptive drugs (drugs that prevent further bone resorption): bisphosphonates; calcitonin (inhibition of osteoclasts/cells that break … Paget’s Disease: Drug Therapy
Obligatory medical device diagnostics. Radiographs of the affected body region, e.g. Skull Vertebral bodies of the lumbar spine Pelvis Femur (thigh bone) Tibia (shin bone) Note: Paget’s disease is usually diagnosed by the characteristic x-ray alone: Early manifestations are osteolytic loosening (bone loss; osteolysis circumscripta cranii; a V-shaped osteolysis in the shaft of long tubular … Paget’s Disease: Diagnostic Tests
1st order Fractures (broken bones) often require osteosynthesis – reunification of bone fragments In advanced osteoarthritis, a joint replacement may need to be installed In the case of malalignment, corrective osteotomies (realignment osteotomy; procedure in which a bone is cut (osteotomized) to establish normal bone, joint or limb anatomy, or to restore it in the … Paget’s Disease: Surgical Therapy
Most patients do not have symptoms. However, the following symptoms and complaints may indicate Paget’s disease: Bone pain in the area of the affected bone Deformities/thickening/fractures (fractures) of the affected bones. Muscle cramps due to incorrect loading Overheating of the affected region due to the formation of new vessels Gait disturbances Osteoarthritis Back pain Spinal … Paget’s Disease: Symptoms, Complaints, Signs
Pathogenesis (disease development) In Paget’s disease, there is overactivity of osteoclasts (“bone-degrading cells”). The resulting excessive bone resorption, mainly subcortical (“lying beneath the bone cortex”), is compensated by excessive new bone formation by osteoblasts (“bone-building cells”) during the course of the disease. As a result, bone is distended and thickened by subperiosteal (“lying below the … Paget’s Disease: Causes
Physical therapy (including physiotherapy) Physiotherapy Massage Electrotherapy Balneotherapy
Medical history (history of illness) represents an important component in the diagnosis of Paget’s disease. Family history Are there any hereditary diseases in your family? Social anamnesis Current medical history/systemic medical history (somatic and psychological complaints). Are you experiencing pain? If yes, when does the pain occur? Where is the pain localized? Back pain? Headache? … Paget’s Disease: Medical History
Musculoskeletal system and connective tissue (M00-M99). Osteomalacia (softening of bone). Neoplasms – tumor diseases (C00-D48) Bone metastases from unspecified neoplasms (often breast carcinoma (breast cancer), prostate carcinoma (prostate cancer)).
