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.

And if you want to follow along with written notes on Paget's,

you can follow along at zero tofinals.com slash Padgett's disease

or in the rheumatology section of the zero definals medicine book.

So let's get straight into it.

Padgett's disease of the bone refers to a disorder of bone turnover.

There's excessive bone turnover, which is excessive formation and reabsorption of bone,

which is due to excessive osteoblast and osteoclast activity.

Remember that osteoblasts put bone into place, and osteoclasts take bone and reabsorb it into the blood.

This excessive turnover is not coordinated, so this leads to patchy areas of high density of bone, which we call sclerosis, and patchy areas of low density of bone, which we call lysis.

This results in enlarged and misshapen bones with structural problems that increase the risk of pathological fractures. It particularly affects

the axial skeleton, which is the bones of the head and the bones of the spine. So how does it

present? Well, Paget's disease of the bone typically affects older adults. It presents with bone pain,

bone deformity, fractures, and it can cause hearing loss if it occurs in the bones around the ear. Let's talk about the key investigations that you need

to remember for your exams. The first is an x-ray of the bone and there's some classic findings that you might find coming up in your exams.

The first is the bones will be enlarged and deformed due to excessive bone turnover.

The next is something called osteoporosis circumscriptor which describes well-defined osteolytic lesions that appear less

dense compared to the normal bone. So this is well-defined lesions that are darker colored because

they're less dense on a background of normal bone. The next thing you might come across is a cotton wool appearance of the skull.

And this describes poorly defined patchy areas of increased density,

or sclerosis, and decreased density, which we call lysis.

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