Paget's Disease Unveiled in a Primary Care Setting: A Case of High Alkaline Phosphatase
Abstract
Paget's disease of bone (PDB) is a moderately common clinical entity that causes bone deformities and focal areas of disorganized new bone formation. It is characterized by abnormal bone remodeling, leading to enlarged and weakened bones. Although often asymptomatic, it can present with localized pain, deformity, or fractures. Elevated alkaline phosphatase (ALP) levels, which are bone-specific, are common biochemical findings of PDB and can be treated with bisphosphonates; however, diagnosing it based on clinical presentation may be challenging due to the asymptomatic nature of the disease, as well as the various factors, causes, and tests required for an accurate diagnosis. We present the case of a 67-year-old male patient who initially presented to the clinic with a right heel fracture and right hip pain, which turned out to be PDB marked by an increased ALP level. A radionuclide bone scan confirmed right pelvic bone deformity and prompted the prescription of zoledronic acid. Lab work was repeated six months later, and a repeat radionuclide bone scan will be performed if the patient experiences any new symptoms. With such cases often being overlooked, especially in primary care settings, this report emphasizes the vital need to monitor biochemical markers, such as ALP. This report highlights the diagnostic process and clinical considerations involved in identifying and managing PDB.
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