Hello and welcome to the Zero to Finals podcast.

My name is Tom and in this episode I'm going to be talking to you about Paget's

Disease of Bone.

And you can find written notes on this topic at zero tofinals.com slash Padgetts

or in the Rheumatology section of the second edition of the zero to finals medicine book,

available now on Amazon. So let's get straight into it.

Padgett's disease of bone involves excessive bone turnover, both reabsorption and formation of bone, due to increased osteoclast and

osteoblast activity. The excessive bone turnover is not coordinated and this leads to patchy

areas of high density or sclerosis and low density or lysis.

The result is enlarged and misshapen bones, structural problems and an increased risk of

pathological fractures. Paget's disease of bone particularly affects the axial skeleton,

which are the bones of the head

and the spine.

The cause of Paget's disease of bone is unknown.

It typically affects older adults.

Let's start with the presentation.

Patients may be asymptomatic and it may be diagnosed incidentally on an x-ray,

or it may present with bone pain, bone deformity, fractures or hearing loss.

Let's go through the investigations.

X-ray findings include bone enlargement and deformity,

osteoporosis circumscriptor, which is well-defined osteolytic lesions that appear less

dense compared with the normal bone, a cotton-wool appearance of the skull, with poorly defined patchy areas of increased and decreased density of bone in the skull,

...