How to Diagnose Paget's Disease

Paget's disease is a localized bone disease in which bone formation and resorption are increased. The bone structure becomes structurally disorganized, causing it to be larger and weaker than normal. Paget's disease is a common bone disorder of the elderly, although up to 90 percent of patients are asymptomatic. The course of this disease has three phases: lytic, mixed and sclerotic. The following steps will show how to diagnose Paget's disease.

Instructions

Difficulty: Challenging

1. Detect Paget's disease incidentally. Most cases of Paget's disease are discovered upon examination for an unrelated matter. The most common symptom, when any exist, is bone pain.
2. Observe less common symptoms of Paget's disease. These can include congestive heart failure, hearing loss, pathologic fractures and weakness.
3. Perform specific tests for Paget's disease. An elevated level of Bone Specific Alkaline Phosphatase is the most specific laboratory result for Paget's disease. Other findings include elevated levels of deoxypyridinoline, C-telopeptide and N-telopeptide in the urine.
4. Use radiographs to find several relatively specific signs of Paget's disease. The boundary between healthy and disordered bone may show as a classic V-shaped pattern in the long bones. A thickened iliopectineal line may be present in the pelvis and the skull may have a characteristic "cotton wool" pattern.
5. Examine abnormal bony architecture histologically. The lytic phase consists of osteolysis, which is soon followed by the mixed phase marked by an accelerated deposit of bone in a random manner. The sclerotic phase consists of accelerated bone formation with an increase in osteoblastic activity.