complications
Last reviewed 10/2021
Complications are seen in around 30% of patients (1).
- fractures
- a frequent complication of Paget's disease
- most commonly arise in the weight-bearing long bones
- typically transverse in nature (similar to a piece of chalk that has snapped) (1)
- those in the femur are associated with a high rate of non - union
- small stress fractures are often very painful.
- on X-ray, they resemble Looser's zone
- osteoarthritis
- is not uncommon in the hip or knee
- thought to be primarily a consequence of the remodelling process rather than of abnormal loading from deformity
- pain caused by arthritis of the hip which results in impaired mobility is the most common cause of hip replacement in Paget's patients (1)
- osteosarcoma
- is a serious complication, occurring in about 1% of patients
- the tumour is particularly invasive and most commonly affects the jaw, pelvis or femur
- it may be the first presentation of Paget's and should be suspected in any elderly patient in which a previously diseased bone becomes increasingly painful, swollen and tender.
- high output cardiac failure
- occurs rarely
- most common in polyostotic disease and is the result of increased bony blood flow.
- hypercalcaemia
- seen in patients whom are immobilised for long periods
- impaired vision, facial palsy, trigeminal neuralgia and deafness are all consequences of cranial nerve compression.
- radiologically both sclerotic and lytic phases are recognized; the lytic phase may be defined in the calvarium of the skull where it is called osteoporosis circumscripta.
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