The photos show Pagets of the tibia - lower leg - bowing - clinical and Xray
Pagets Disease is a metabolic bone disease that involves bone destruction and regrowth that results in deformity. The patient is frequently entirely assymptomatic and the condition can be discovered after routine Xrays, requested for other reasons. However of those people who become symptomatic, the commonest features are:
Deformity of bone
Manifestations of complications.
Detail of the thickened and irregular bone structure
In pagets disease, the remodelling process(by osteoclast and osteoblast) is disordered, with large abnormal osteoclasts working at a much greater turnover than normal, followed by the irregular laying down of bone
Gone are the days where pain killers and antiinflammatories were the only approach. The mainstay of therapy at the current state of the art is that of bisphosphonates, either oral or intravenous pulse. Such preperations include - alendronate(oral), risedronate (oral) and pamidronate (intravenous) . Such therapy results in a reduction in the alkaline phosphatase, and reduction in pain.