Imaging Pearls ❯ Musculoskeletal ❯ Pagets Disease
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- Paget disease is a skeletal growth disorder in which abnormalities such as unusual bone growth can occur in several multifactorial ways. It is the second most frequently diagnosed metabolic bone disease after osteoporosis. It is often manifested by diffuse pain and radiologically visible bone changes throughout the musculoskeletal system. The disease can affect any bone in the body but is more often seen in the spine, pelvis, and skull. It does not spread to other bones but can deteriorate in the affected area and even progress to a sarcoma, which may be a fatal bone cancer. The most common biochemical finding is elevated levels of alkaline phosphatase, bone-specific. It can be treated very effectively with the use of bisphosphonates.
Paget Bone Disease [Updated 2023 Nov 12]. In: StatPearls [Internet].
Bouchette P, Boktor SW.
Treasure Island (FL): StatPearls Publishing; 2025 Jan - The condition presents with excess osteoclastic activity followed by a compensatory increase in osteoblastic activity, leading to the formation of disorganized bone, which is less compact, mechanically weaker, highly vascular, and more susceptible to fracture. Fortunately, more than three-fourths of patients with Paget disease are asymptomatic. It is the second most commonly seen metabolic bone disorder in older individuals after osteoporosis. The condition can affect 1 or more bones, but the axial skeleton is most often involved (spine, pelvis, and skull). The condition does not spread to other bones but can progress in the preexisting site. A deadly complication of Paget disease is the development of pagetic sarcoma, a tumor that can be fatal.
Paget Bone Disease [Updated 2023 Nov 12]. In: StatPearls [Internet].
Bouchette P, Boktor SW.
Treasure Island (FL): StatPearls Publishing; 2025 Jan - Paget disease is usually seen in individuals older than 50 years of age. Around the world, it is reported that the prevalence of the disease has decreased during the past 2 decades, currently estimated between 1.5% to 8.3%. It is common in Caucasians of northern European descent. Paget disease is equally common in males and females. In the US, it is said to affect 1 to 3 million people, but most of the patients are asymptomatic. The disorder is slightly more common in white males. The disorder usually presents in the fourth to fifth decade of life, but the diagnosis is often made a decade later.
Paget Bone Disease [Updated 2023 Nov 12]. In: StatPearls [Internet].
Bouchette P, Boktor SW.
Treasure Island (FL): StatPearls Publishing; 2025 Jan - The differential diagnosis of Paget disease includes the following:
Osteomalacia
Osteoporosis
Malignancy of the bone, primary or metastatic
Renal osteodystrophy
Osteoarthritis
Osteopenia
Fibrous dysplasia
Paget Bone Disease [Updated 2023 Nov 12]. In: StatPearls [Internet].
Bouchette P, Boktor SW.
Treasure Island (FL): StatPearls Publishing; 2025 Jan
- Pagets Disease: Facts
- Increased incidence with age
- Up to 10% of caucasians over age 85 have Pagets disease
- Most patients asymptomatic although others may have fatigue, peripheral nerve compression, pain, enlarging hat size
- Usually polyostotic and involves multiple bones often simultaneously - Pagets Disease: Facts
- Pelvis most common site of involvement followed by lumbar spine, thoracic spine, proximal femur, calvarium.
- Complications include neoplasms like osteosarcoma, chondrosarcoma, and fractures including insufficiency fractures