complications

Last reviewed 10/2021

Complications are seen in around 30% of patients (1).

  • fractures
    • a frequent complication of Paget's disease
    • most commonly arise in the weight-bearing long bones
    • typically transverse in nature (similar to a piece of chalk that has snapped) (1)
    • those in the femur are associated with a high rate of non - union
    • small stress fractures are often very painful.
    • on X-ray, they resemble Looser's zone
  • osteoarthritis
    • is not uncommon in the hip or knee
    • thought to be primarily a consequence of the remodelling process rather than of abnormal loading from deformity
    • pain caused by arthritis of the hip which results in impaired mobility is the most common cause of hip replacement in Paget's patients (1)
  • osteosarcoma
    • is a serious complication, occurring in about 1% of patients
    • the tumour is particularly invasive and most commonly affects the jaw, pelvis or femur
    • it may be the first presentation of Paget's and should be suspected in any elderly patient in which a previously diseased bone becomes increasingly painful, swollen and tender.
  • high output cardiac failure
    • occurs rarely
    • most common in polyostotic disease and is the result of increased bony blood flow.
  • hypercalcaemia
    • seen in patients whom are immobilised for long periods
  • impaired vision, facial palsy, trigeminal neuralgia and deafness are all consequences of cranial nerve compression.
  • radiologically both sclerotic and lytic phases are recognized; the lytic phase may be defined in the calvarium of the skull where it is called osteoporosis circumscripta.

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