Symptoms

As already described above, a distinction is made between an asymptomatic and a symptomatic course of the disease. An asymptomatic course means that the disease was diagnosed as a so-called “random finding” and no main place of manifestation can be determined. Patients with a symptomatic course of the disease have pain, especially in the musculoskeletal system (especially: spinal pain).

Common to both courses of Paget’s disease is that the increased activity of the osteoclasts means that more waste products have to be excreted from the body. These “waste products” include amino acids (especially hydroxyproline) and can be detected in urine. The osteoblasts, on the other hand, try to build up bone mass and balance the osteoclast process.

This activity can be demonstrated, for example, by a blood test laboratory value. The increased activity of the osteoblasts leads to an increase in the enzyme “alkaline phosphatase” (= AP). Alkaline phosphatase is found in many organs, such as the liver, so it is important to determine the “boil-specific AP” = ALP or ostease in the blood.

Which parts of the body are affected by Paget’s disease can vary.Whether there is a main manifestation site (symptomatic form of Paget’s disease) varies from individual to individual. Possible symptoms of Paget’s disease are listed below Development of malignant recurrences (= new formations) (rather rare: <1%), transition to osteosarcoma.

Deformations of the bones
Increased probability of fracture (risk of fracture)
Localized pain
Cardiovascular load
Muscle cramps due to incorrect strain
Overheating due to formation of new blood vessels
Varicose vein formation (varicosis)
Narrowing of various nerve tracts (nerve compression)

Diagnosis

X-rays are of paramount importance because they allow the osteolysis (bone dissolution) to be detected in the early stages of the disease and later the coarse stringy structure of the cancellous bone (= sponge-like framework of fine bone beams) typical of the disease. The increased bone remodeling can also be detected and depicted with a bone scintigraphy. As a rule, these bone remodeling processes are confirmed by means of an X-ray image after the scintigraphy.

The high accumulation in the right thigh bone (femur) due to the high activity of the bone metabolism can be seen very clearlyAn increased activity of the osteoclasts, on the other hand, leads to increased degradation and consequently to the formation of waste products that must be excreted from the body. These “waste products” include amino acids (hydroxyproline) and can be detected in the urine. As already described in the subchapter “Symptoms”, the increased activity of osteoblasts can be detected by the increase in the enzyme “alkaline phosphatase” (= AP), especially the “bone-specific alkaline phosphatase” ALP.

However, a differential diagnosis must be made to exclude the possibility of liver disease, as this can also be held responsible for the increase in AP. In cases where the diagnosis still seems unclear after all examination methods, a bone biopsy (obtaining a tissue sample) can be performed. Furthermore, Paget’s disease must still be differentially diagnosed from bone metastases and other bone diseases such as osteomalacia (= increased soft tissue and bending tendency of the bones due to defective incorporation of minerals into the osteoid).