J Bone Metab.  2020 Feb;27(1):71-75. 10.11005/jbm.2020.27.1.71.

Paget's Disease of Bone Affecting Peripheral Limb: Difficulties in Diagnosis: A Case Report

Affiliations
  • 1Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.
  • 2Department of Pathology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.
  • 3Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea. raisondetre@hanmail.net

Abstract

In terms of management of Paget's disease of bone (PDB), early diagnosis and proper management achieving remission is essential with lifelong specialist follow-up. We present the case of a 40-year-old woman with PDB affecting mainly the distal extremities (ankle and wrist). The patient visited our hospital in 2012 with heel pain. Plain radiography revealed osteoporosis, and a bone scan revealed hot uptake. Initial laboratory investigations showed normal serum calcium, 25-hydroxy-vitamin D, and parathyroid hormone levels; however, osteocalcin, C-terminal telopeptide of type I collagen, and bone alkaline phosphatase levels were elevated. A bone mineral density scan showed T- and Z-scores of −2.5 and −2.7, respectively, and bisphosphonate treatment was initiated. Biopsy performed on the calcaneal lateral wall revealed inconclusive findings. Follow-up biopsy on the left distal radius was performed 7 years later to investigate wrist pain, and this examination led to a final diagnosis as PDB. We suggest inconclusive biopsy result during the early phase of PDB and highly recommend follow-up evaluation in osteoporosis with atypical behavior.

Keyword

Alkaline phosphatqse; Biopsy; Diphosphonates; Osteitis deformans

MeSH Terms

Adult
Alkaline Phosphatase
Biopsy
Bone Density
Calcium
Collagen Type I
Diagnosis*
Diphosphonates
Early Diagnosis
Extremities*
Female
Follow-Up Studies
Heel
Humans
Osteitis Deformans*
Osteocalcin
Osteoporosis
Parathyroid Hormone
Radiography
Radius
Specialization
Wrist
Alkaline Phosphatase
Calcium
Collagen Type I
Diphosphonates
Osteocalcin
Parathyroid Hormone
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