Protocolo diagnóstico y tratamiento de la enfermedad ósea de Paget

Abstract

Paget's disease of bone (PDB) is the second most common metabolic bone disease. Its diagnosis is incidental in many cases, based on the presence of characteristic lesions observed on imaging studies ordered for other reasons or an isolated elevation of alkaline phosphatase levels on laboratory tests. Pain in the affected area is the primary clinical manifestation in symptomatic cases. Plain x-ray —primarily of the skull, spine, pelvis, and tibias— and bone scintigraphy are the most common diagnostic techniques, with computed tomography and magnetic resonance imaging reserved for uncertain cases. Treatment is primarily indicated when there is bone pain, although it is also considered if the affected bones are at risk of deformity. Treatment for the sole purpose of normalizing bone formation markers is not advised. Intravenous zoledronate is the treatment of choice and orthopedic surgery is necessary in cases of marked deformity and osteoarthritis.