Diagnostic Considerations

The differential diagnosis of Paget disease includes osteomalacia, which may be part of the spectrum of osseous abnormalities accompanying chronic renal insufficiency. Patients with mild osteomalacia may present with nonspecific bone pain and tenderness. Elevated levels of bone-specific alkaline phosphatase may occur in osteomalacia or in Paget disease.

Both disorders may result in fractures. However, in Paget disease, distinctive horizontal radiolucencies are visible on the convex surface of the bone, whereas in osteomalacia they are visible on the concave aspects of the bone.

Both Paget disease and skeletal metastasis can produce bone pain and radiographically similar lytic lesions. Diagnostic confirmation may require biopsy.^[4]

Differential Diagnoses

Workup

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Media Gallery

Radiograph showing a 44-year-old African American man with characteristic changes of Paget disease in the left hemipelvis.
Radiograph showing a 72-year-old white woman with Paget disease of the lower leg and typical bowing.
Dual-energy x-ray absorptiometry scan of a 72-year-old white woman with Paget disease of the lower leg and typical bowing (same patient as in Image 2).

of 3

Author

Mujahed M Alikhan, MD Rheumatologist

Mujahed M Alikhan, MD is a member of the following medical societies: American College of Physicians, American College of Rheumatology

Disclosure: Nothing to disclose.

Coauthor(s)

Karen Driver, MS Medical Writer, Procter and Gamble Company

Disclosure: Nothing to disclose.

Kristine M Lohr, MD, MS Professor, Department of Internal Medicine, Interim Chief, Division of Rheumatology, Director, Rheumatology Training Program, University of Kentucky College of Medicine

Kristine M Lohr, MD, MS is a member of the following medical societies: American College of Physicians, American College of Rheumatology

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

Laura D Carbone, MD, MS Professor of Medicine, Division of Connective Health Diseases, Director, Memphis Metabolic Bone Center, Department of Medicine, University of Tennessee Health Science Center College of Medicine

Laura D Carbone, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American College of Rheumatology, American Medical Women’s Association, American Society for Bone and Mineral Research; and International Society for Clinical Densitometry

Disclosure: Novartis Honoraria Consulting, Speaking and teaching; P&G Honoraria Consulting, Speaking and teaching

Elliot Goldberg, MD Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine

Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology

Disclosure: Nothing to disclose.

Marlon J Navarro, MD Fellow, Department of Rheumatology, University of Tennessee at Memphis

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment