Introduction
Paget’s disease of bone (PDB) is a disorder of accelerated bone turnover, leading to focal disorganised skeletal structure. The incidence of PDB has declined significantly in the past 30 years, leading to lower clinical familiarity with the condition. A short course of bisphosphonate therapy is first-line and has long term efficacy in many cases. We examine two cases of Paget’s disease, one under-treated and one over-treated with bisphosphonates.
Cases
We present the cases of two elderly men with Paget’s Disease, each presenting to a tertiary hospital with a femoral fracture. The first patient was under-treated as evidenced by multiple osteolytic lesions and prolonged elevation of alkaline phosphatase. The second patient was treated with daily oral bisphosphonate therapy for over 20 years, and presented with atypical femoral fracture.
Discussion
PDB is a disorder of skeletal remodelling that can result in localised bone pain, deformity, and fractures. Treatment with bisphosphonate therapy is indicated for a brief period in symptomatic disease and particular asymptomatic cases. These two cases highlight the risks of under and over treatment, and the importance of long term follow up.