Musculoskeletal Diseases: Paget's Disease

http://www.glogster.com/casee74031/paget-s-disease/g-6lmv59r283mrusf2bkea3a0

Paget's Disease is a chronic deformation of the skeleton where the normal bones are resorbed (breaks down into Ca2+ and alkaline phosphatase) into the blood stream and the normal bone deposits are replaced by vascular, fibrous connective tissue that is larger, but disorganized and structurally weaker.  It's a disease more common in elderly patients.

S/S:
systemically: pathological fractures, insidious bone pain, fatigue, progressively developing waddling gait, "shrinking" height.
nervous system (from thickening of skull and spinal compression): H/A, dementia, visual deficits, hearing loss.
cancerous cells: osteosarcoma, fibrosarcoma, osteoclastoma tumors

Dx tests:
x-ray
high serum alkaline phosphatase levels
increased uptake of radiolabeled bisphosphate

Tx: Mainly what can be offered is symptomatic and supportive care, and then, in extreme cases, surgical correction of the bone deformities. Since the main symptom is bone resorption, patients are given drugs to prevent bone resorption (bisphosphate, calcitonin) and to increase healthy bone building (zoledronic acid, calcium, and vit D).  Pain is managed with NSAIDS.  Oftentimes patients will be prescribed some form of back support or corset to wear when out of bed, and the bed itself will be firm.


References:
Brucher, L., Dirksen, S.R., Harding, M.M., Heitkemper, M.M., & Lewis, S.L.  (2014).  Medical Surgical Nursing (pp. 174, 212, 1568-1576) St. Louis, MO: Elsevier Mosby.