A 91 year old woman was admitted with subacute bowel obstruction, which resolved with conservative management. Discharge was delayed, however, because of poor mobility secondary to gross bone deformation (fig 1 and 2). The patient's biochemistry showed a markedly raised concentration of alkaline phosphatase, with normal serum concentrations of calcium and phosphate.
This is made on the basis of biochemical and radiographic findings. The hallmark of Paget's disease is a raised concentration of alkaline phosphatase, in the presence of normal serum concentrations of calcium and phosphate, reflecting the greatly increased bone turnover. However, mild hypercalcaemia may follow prolonged immobilisation. Levels of urinary hydroxyproline, a normal breakdown product of collagen, are also markedly increased, and this and the concentration of alkaline phosphatase parallel the course of the disease and provide useful markers of therapeutic progress.
Radiographically, Paget's disease starts at one site in a bone and gradually extends, the advancing front