Metastatic Bone Disease Secondary to Bronchial Adenocarcinoma in a Patient with Paget’s Disease of the Bone

AbstractPaget’s disease of bone (PDB) is the second most common metabolic bone disease. Bisphosphonates (BPs) are currently the drugs of choice for PDB. PDB and osteomalacia are both common in the elderly. The concept of relative vitamin D deficiency in patients with PDB was suggested long ago, but it has not yet elucidated. Both diseases predispose to fractures, but their combined action to fragility has not been studied yet. The older BPs, mainly etidronate, further inhibit bone mineralization. Mineralization defects have also been described in patients with PDB treated with pamidronate. Moreover, hypocalcemia and secondary hyperparathyroidism after treatment with BPs have been described in PDB. Hypocalcemia seems to be more severe after treatment with the more potent, intravenous zoledronic acid, which is currently the treatment of choice for PDB. The counteracting hyperparathyroidism pathophysiologically intends to increase renal reabsorption of calcium and 1.25-dihydroxy vitamin D production and to stimulate osteoclasts in order to prevent long-term hypocalcemia. However, the effect of PTH on osteoclasts is, at least partly, restricted in patients taking BPs. Secondary hyperparathyroidism is a potentially detrimental condition, especially in patients already suffering from another bone disease. Serum calcium and vitamin D deficiency should be restored before BP treatment and calcium and vitamin D administration should be possibly continued for longer after achieving normocalcemia, which may shorten the duration of secondary hyperparathyroidism.Mineralization defects and hypocalcemia with secondary hyperparathyroidism have been described in patients with Paget’s disease of bone treated with bisphosphonates. Secondary hyperparathyroidism may be a potentially detrimental condition for patients with Paget’s disease of bone.

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The Second Most Common Bone Disease: A Review on Paget’s Disease of Bone

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-008-8208-4 ◽

2008 ◽

Vol 34 (6) ◽

pp. 549-553 ◽

Cited By ~ 10

Author(s):

Sebastian Seitz ◽

Matthias Priemel ◽

Christoph von Domarus ◽

F. Timo Beil ◽

Florian Barvencik ◽

...

Keyword(s):

Bone Disease ◽

Paget’S Disease ◽

Paget's Disease ◽

Paget’S Disease Of Bone ◽

Paget's Disease Of Bone

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Skull Abnormalities in Cadavers in the Gross Anatomy Lab

BioMed Research International ◽

10.1155/2020/7837213 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Jessica De Rose ◽

Brian Laing ◽

Maha Ahmad

Keyword(s):

Bone Disease ◽

Bone Growth ◽

Paget’S Disease ◽

Gross Anatomy ◽

Paget's Disease ◽

Frontal Bone ◽

Growth Patterns ◽

The Body ◽

Radiological Examination ◽

Anatomy Laboratory

Background. The skull encompasses and houses one of the most important organs in the body—the brain—and like all tissues in the body, it is comprised of living cells that are constantly remodeling as this maintains the strength and homeostasis of the bone. In the present study, abnormal bone growth patterns were observed and the possible causes of said findings were investigated in multiple cadaver skulls dissected during head and neck anatomy courses at Detroit Mercy Dental over the past year. There are many factors, both intrinsic and extrinsic, with differences in stimulation to the skull resulting in skull abnormalities. Materials and Methods. For this study, skull abnormalities were examined from 65 formalin-embalmed cadaver heads, obtained from the Gross Anatomy Laboratory at the University of Detroit Mercy School of Dentistry between the years 2016 and 2019. We have recorded the age, sex, and previous chief medical issues of all lab specimens used in the study. Skulls were later evaluated for possible indications of bone disease such as hypertosis frontalis interna (HFI) or Paget’s disease. Results. Among the sixty-five specimens provided to the Detroit Mercy Dental cadaver lab, 19 specimens (29%) were found to present with irregular, undulating, thickening of the frontal bone internal surface. The findings located on the skulls closely resembled the gross anatomic appearance of HFI or Paget’s disease; however, a conclusive diagnosis of these skull abnormalities cannot be made without a pathologist biopsy and radiological examination. Twelve of the nineteen specimens that displayed possible bone disease, approximating 63% prevalence, were females; their ages ranged from 68 to 95 years old. Thus, seven of the nineteen specimens exhibiting features of skull abnormalities, approximating 36% prevalence, were males with ages ranging from 70 to 103 years old. In addition, five of these nineteen specimens collected (26% prevalence) had been diagnosed with neurological disorders, including Alzheimer’s, dementia, depression, and Parkinson’s disease. In the current study, the proportion of specimens exhibiting skull abnormalities was higher compared to the overall prevalence observed in previous studies. Conclusion. Possible causes of observed anatomical abnormalities in the skull of cadavers of a gross anatomy laboratory were investigated, and it was determined that hypertosis frontalis interna (HFI) may contribute to such abnormalities. This is a condition that affects bone growth in the frontal skull. Our numbers of skull abnormalities were higher than previous studies and might be due to the fact that HFI was predominately present as an incidental finding during imaging of postmenopausal females or observed postmortem in cadavers. In addition, Paget’s disease or hormonal imbalances could also result in similar features, and thus cannot be ruled out as a plausible cause. Paget’s disease causes the bone to deposit at a faster rate than normal, which will result in thick and brittle bone. Studies that will involve further examination of new cadavers for the presence of HFI is needed, either using biopsy specimens and/or radiological examination to explore possible causes for the abnormal bone growth in the frontal bone.

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Advances in the molecular pharmacology and therapeutics of bone disease and International Symposium on Paget’s Disease July 10–14, 2007 St. Catherine’s College, Oxford, UK

Bone ◽

10.1016/j.bone.2007.08.024 ◽

2007 ◽

Vol 41 (6) ◽

pp. 1059-1062 ◽

Cited By ~ 1

Author(s):

T. John Martin ◽

Stuart H. Ralston

Keyword(s):

International Symposium ◽

Bone Disease ◽

Paget’S Disease ◽

Paget's Disease ◽

Molecular Pharmacology

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Paget’s Disease of Bone Affecting Site With Orthopedic Hardware

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.427 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A210-A210

Author(s):

Ivan A Serrano Santiago ◽

Jessica Lucier ◽

Steven Michael Petak

Keyword(s):

Vitamin D ◽

Bone Disease ◽

Tibial Fracture ◽

Paget’S Disease ◽

Paget's Disease ◽

Paget’S Disease Of Bone ◽

Bone Architecture ◽

Paget's Disease Of Bone ◽

Vitamin D Levels ◽

25 Oh Vitamin D

Abstract Introduction: Paget’s disease of bone is a focal disorder of accelerated bone remodeling which leads to bone hypertrophy, cortical expansion and abnormal bone architecture. Either a single bone (monostotic) or multiple bones (polyostotic) can be affected. Although it has been suggested to be caused by a chronic slow viral infection of the bone, a cause and effect relationship has not been clearly established. Therefore, the etiology of Paget’s disease remains an uncertain and controversial topic of discussion. Case Description: A 62-year-old African American male with a past medical history of a left tibial fracture presented with worsening left leg pain for the past 6 months. He denied any recent traumatic events, falls or strenuous physical activity. Since the pain started, his ambulation had been significantly affected requiring the use of a cane for gait stability. His left tibial fracture occurred over 20 years ago after landing on another person’s foot while playing basketball. It was surgically treated with intramedullary nailing and metal rod insertion into the canal of the tibia. Since then, he remained an active person with no physical limitations or ailments until the recent developments that brought him to clinic. A left leg CT-Scan ordered for evaluation of the tibial hardware revealed cortical thickening, marrow expansion and coarse trabeculae throughout the majority of the tibia consistent with Paget’s disease. The hardware was intact with no peri-hardware lucency to suggest loosening or infection. His laboratory workup showed a normal alkaline phosphatase level (94 U/L; normal range 40 - 115 U/L) and low 25-OH Vitamin D level of 14. A Radionuclide Bone Scan done for evaluation of location and extent of bone disease resulted in diffusely abnormal uptake present in the left tibia with no other locations of suspicious uptake. After his 25-OH Vitamin D levels were replenished, a dose of Zoledronic acid IV infusion was given with significant improvement of pain several months after. Discussion: Paget’s disease of bone is the second most common bone disease after osteoporosis. Affected skeletal sites develop a disorganized mosaic of woven and lamellar bone more susceptible to deformities and fractures than normal bone. It is often asymptomatic, but classical features include bone pain experienced either at rest or with motion, cutaneous erythema and warmth. The goal of medical therapy is to relieve symptoms and to prevent future complications with high potency bisphosphonates. Although it is well known that Paget’s disease increase the risk of fractures, this case brings up an interesting take about the possibility of fractures managed with hardware placement increasing the risk of Paget’s disease in the involved site.

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