Bone Abstracts

Background: Pagets disease of bone is a focal disorder of accelerated bone turnover that is frequently under-recognised, particularly when asymptomatic or mistaken for degenerative joint disease. An isolated elevation in alkaline phosphatase (ALP) often represents an early biochemical clue, yet abnormal results are commonly attributed to hepatobiliary disease, resulting in delayed diagnosis. Earlier recognition is important to reduce preventable complications. This case series evaluates diagnostic patterns in a single-centre cohort and highlights practical opportunities to support earlier case identification.

Methods: A retrospective review of 19 patients diagnosed with Pagets disease at a district general hospital was undertaken between (2004-2023). Data collected included age, sex, ethnicity, presenting features, anatomical distribution, ALP levels at diagnosis and most recent follow-up, complications, treatment, and family history. Imaging findings from radiographs, CT, and nuclear bone scans were reviewed.

Results: The cohort (mean age 74 years; 53% female; 89.5% British White) most commonly presented with joint pain (72%), followed by incidental radiological findings (11%) and isolated raised ALP (11%). Overall, 85% had elevated ALP at diagnosis (range 1041550 IU/L). The pelvis was the predominant site (68.4%), followed by skull (21.1%), vertebrae (21.1%), and jaw (5.3%). Bone scans demonstrated increased uptake in all cases. Family history was positive in two cases. Zoledronic acid was the main treatment (84%). ALP showed substantial improvement, decreasing from a median 274 IU/L at diagnosis to 92 IU/L (range 58-251) at follow-up. Complications were infrequent and included hearing impairment (n2) and chronic jaw infection (n1).

Conclusion: Pagets disease often presents heterogeneously and may be overlooked when ALP is misattributed to liver disease. In patients with isolated raised ALP and normal hepatic markers, early evaluation of bone origin and timely imaging are essential. A simplified diagnostic pathway may support earlier detection and reduce avoidable complications.