CASE REPORT
Monostotic Paget’s disease of bone – literature review
and case report
1
Department of Rheumatology, Municipal Hospital Complex, Olsztyn, Poland
2
Department of Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
Submission date: 2019-02-28
Final revision date: 2019-06-02
Acceptance date: 2019-06-09
Online publication date: 2019-06-28
Publication date: 2019-06-28
Reumatologia 2019;57(3):167-172
KEYWORDS
TOPICS
ABSTRACT
Paget’s disease of bone (PDB) is a localized, chronic bone metabolic disorder, characterized by an osteoclastic malfunction, causing increased bone resorption and subsequent compensatory creation of new bone with a defective microstructure. Monostotic cases of PDB are less common than asymmetrical polyostotic PDB cases. The radiological diagnosis of PDB is usually straightforward, but monostotic cases can cause diagnostic difficulties.
We report a case of monostotic PDB in a 64-year-old man. He experienced pain of the left lower extremity and radiological investigations revealed irregular areas of bone destruction in the left femur. Bone biopsy findings indicated PDB. Treatment with bisphosphonates was initiated, but after about three years of treatment left hip arthroplasty was required due to a large area of bone destruction. Presentation of this case report aims to discuss diagnostic challenges of monostotic cases of PDB and present guidelines of treatment.
We report a case of monostotic PDB in a 64-year-old man. He experienced pain of the left lower extremity and radiological investigations revealed irregular areas of bone destruction in the left femur. Bone biopsy findings indicated PDB. Treatment with bisphosphonates was initiated, but after about three years of treatment left hip arthroplasty was required due to a large area of bone destruction. Presentation of this case report aims to discuss diagnostic challenges of monostotic cases of PDB and present guidelines of treatment.
REFERENCES (26)
1.
Crego-Vita D, Aedo-Martín D, Sánchez-Pérez C. Case report of early aseptic loosening of total hip arthroplasty in monostotic paget disease, a diagnostic challenge. Int J Surg Case Rep 2016; 24: 215-218.
2.
Al-Rashid M, Dipak B, Raskin K, et al. Paget disease of bone. Orthop Clin North Am 2015; 46: 577-585.
3.
Kravets I. Paget’s Disease of Bone: Diagnosis and Treatment. Am J Med 2018; 131: 1298-1303.
4.
Bachiller-Corral J, Díaz-Migueland C, Morales-Piga A. Monostotic Paget’s disease of the femur: A diagnostic challenge and an overlooked risk. Bone 2013; 57: 517-521.
6.
Kurihara N, Hiruma Y, Yamana K, et al. Contributions of the measles virus nucleocapsid and the SQSTM1/p62(P392L) mutation to Paget’s disease. Cell Metab 2011; 13: 23-34.
7.
Tan A, Ralston SH. Clinical presentation of Paget’s disease: evaluation of a contemporary cohort and symptomatic review. Calcif Tissue Int 2014; 95: 385-392.
8.
Bolland MJ, Cundy T. Paget’s disease of bone: clinical review and update. J Clin Pathol 2013; 66: 924-927.
9.
Smith SE, Murphey MD, Motamedi K, et al. From the archives of the AFIP. Radiologic spectrum of Paget disease of bone and its complications with pathologic correlation. Radiographics 2002; 22: 1191-1216.
10.
Theodorou DJ, Theodorou SJ, Kakitsubata Y. Imaging of Paget disease of bone and its musculoskeletal complications: review. AJR Am J Roentgenol 2011; 196: S64-S75.
11.
Appelman-Dijkstra NM, Papapoulos SE. Paget’s disease of bone. Best Pract Res Clin Endocrinol Metab 2018; 32: 657-668.
12.
Ralston SH, Langston AL, Reid IR. Pathogenesis and management of Paget’s disease of bone. Lancet 2008; 372: 155-163.
13.
Wat WZ. Current perspectives on bisphosphonate treatment in Paget’s disease of bone. Ther Clin Risk Manag 2014; 10: 977-983.
14.
Langston AL, Campbell MK, Fraser WD, et al. PRISM Trial Group. Randomized trial of intensive bisphosphonate treatment versus symptomatic management in Paget’s disease of bone. J Bone Miner Res 2010; 25: 20-31.
15.
Reid IR. Osteoporosis treatment: focus on safety. Eur J Intern Med 2013; 24: 691-697.
16.
Black DM, Kelly MP, Genant HK, et al. Bisphosphonates and fractures of the subtrochanteric or diaphyseal femur. N Engl J Med 2010; 362:1761-1771.
17.
Meier RP, Perneger TV, Stern R, et al. Increasing occurrence of atypical femoral fractures associated with bisphosphonate use. Arch Intern Med 2012; 172: 930-936.
18.
Dell RM, Adams AL, Greene DF, et al. Incidence of atypical nontraumatic diaphyseal fractures of the femur. J Bone Miner Res 2012; 27: 2544-2550.
19.
Cummings S. The Adverse Effects and Safety of Bisphosphonates. Bone 2010; 46: S16-S16.
20.
Reid IR, Sharma S, Kalluru R, et al. Treatment of Paget’s Disease of Bone with Denosumab: Case Report and Literature Review. Calcif Tissue Int 2016; 99: 322-325.
21.
Schwarz P, Rasmussen AQ, Kvist TM, et al. Paget’s disease of the bone after treatment with Denosumab: a case report. Bone 2012; 50: 1023-1025.
22.
Grasemann C, Schündeln MM, Hövel M, et al. Effects of RANK-ligand antibody (denosumab) treatment on bone turnover markers in a girl with juvenile Paget’s disease. J Clin Endocrinol Metab 2013; 98: 3121-3126.
24.
Singer FR, Bone HG 3rd, Hosking DJ, et al. Paget’s disease of bone: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014; 99: 4408-4422.
25.
Silverman SL. Paget disease of bone: therapeutic options. J Clin Rheumatol 2008; 14: 299-305.
Copyright: © Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
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