12. Bone Disorders: Paget's Disease of Bone

Paget's Disease of Bone

Chronic condition of disorganized bone remodeling -> thick, weak bones

Pathophysiology

• Excessive osteoclast activity → compensatory osteoblast response → large, disorganized bone with poor strength

Signs and Symptoms

• Bone pain (especially pelvis, skull, spine, legs)\

• Enlarged or deformed bones

• Hearing loss (skull involvement)

• Fractures

• increased hat size

Risk factors

• Male over 50 years old

• Genetic predisposition

• European Descent

• viral Triggers (e.g., paramyxovirus)

Diagnostics

• increased ALP (bone isoenzyme)

• Normal calcium and phosphate

• X-ray: Enlarged bones with thickened cortex

• Bone scan: increased uptake in active lesions]

Nursing management

• Monitor for fractures, pain, hearing loss

• Promote safe mobility

• Use assistive devices

• Evaluate need for surgery if deformity is severe

Pharmacologic Treatment

• Bisphosphonates (e.g., zoledronate): Suppress osteoclast activity

• Calcitonin: Inhibits bone resorption

• Pain management (NSAIDs, Acetaminophen

Surgical Interventions

🔩 Joint Replacement (Hip/Knee Arthroplasty)

• Indication: Severe joint degeneration or deformity due to Paget’s disease

• Purpose: Relieve pain and restore mobility with artificial joint

• Post-op: Standard arthroplasty care — early mobilization, DVT prevention, physical therapy

🛠 Fracture Repair / Deformity Correction

• Indication: Pathologic fractures or limb deformity

• Purpose: Stabilizes and corrects abnormal bone architecture

• Post-op: Higher bleeding risk due to hypervascular bone → monitor hemodynamics