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Adult Bone Diseases Notes

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This is an extract of our Adult Bone Diseases document, which we sell as part of our Orthopaedics Notes collection written by the top tier of University Of Leicester students.

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Paget's Disease An increased number of osteoclasts and osteoblasts causes increased bone turnover resulting in remodeling, bone enlargement, deformity and weakness Second most common bone disorder after Osteoporosis Pathogenesis Increased osteoblast and osteoclast activity alters normal bone remodeling process. Cycles of excessive and disorganized bone reabsorption and formation result in increased bone turnover and therefore bones that are weak and prone to fracture Clinical features
- Often asymptomatic
- Can present with severe bone pain that is o Deep, burning, worse at night, severe, not relieved by analgesia
- May present with bone deformity
- Enlargement of the skull (frontal bossing), femur, tibia (bowed tibia), clavicle
- Pathological fractures
- Nerve deafness (overgrowth of temporal bone compresses vestibular nerve) Investigations
- Bloods o Bone profile: Calcium, phosphate usually normal o Alk. Phos markedly raised (increased osteoclast activity)
- Urine o Increased urinary hydroxyproline (derived from bone collagen) o Useful in monitoring disease activity
- Xrays o Enlargement of bones o Gross bone distortion and deformity o Mixed osteolytic/sclerotic areas o Patchy cortical thickening Management Asymptomatic patients don't require treatment Indications for treatment
- Active disease at skull base or spine above C2 or any neuro compromise
- Pain
- Progressive deformity
- Complications e.g high output cardiac failure Treatment
- Analgesia
- Bisphosphonates to inhibit bone reabsorption
- Calcitonin useful for severe pain or extensive lytic disease o 6-12 months for maximum effectiveness
- Surgery to relieve compression neuropathy ComplicationsOther complications v. rare o High output cardiac failure o Neurological symptoms (compression, hearing loss, spinal stenosis)

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