PAGET’S DISEASE
Presented by-
RIYA KUMARI
BASIC BSC 2ND YEAR
COLLEGE OF NURSING
INTRODUCTION
Paget’s disease, or osteitis deformans, is a metabolic
disorder of bone remodeling, or turnover, in which
increased resorption or loss results in bone deposits
that are weak, enlarged and disorganized.
DEFINITION
• It is defined as idiopathic bone disorder
characterized by excessive abnormal bone
reabsorption followed by formation of fibrous tissue
and new bone that is larger, weaker and prone to
fracture.
INCIDENCE
•It is common in England.
•It is uncommon in Egypt and Middle East.
•Age: It affects older person.
•Sex: More common in males.
CAUSES
The exact cause of Paget’s disease is not known.
Some of the factors that causes are:-
•Autosomal dominant inheritance.
•Slow virus infection of bone.
• Childhood Vitamin D deficiency.
•Autoimmune dysfunction.
PATHOPHYSIOLOGY
Due to genetic and environmental or
unknown factors
⬇️
Proliferation of osteoclasts
⬇️
Increased bone resorption
⬇️
Activation of compensatory mechanism
⬇️
Increased in osteoblastic activity
⬇️
Replaces the bone(bone synthesis)
⬇️
Repeated activities of osteoclasts and osteoblasts
⬇️
Disorganized mosaic of bone formation
CLINICAL
MANIFESTATION
About 10-20% persons are asymptomatic and the
disease is discovered incidentally on x-rays or
laboratory investigations.
Thesymptomatic patient have insidious onset of one
or more of the following:-
🟣Deep, aching bone pain
🔴Skeletal deformity (barrel shaped chest,
enlarged thick skull, bowing of legs i.e., tibia or femur,
hyposis).
🔵 Alteration in skin temperature(flushed, warm skin).
🟤Pathological fracture.
🟢Nerve compression i.e.,cranialNerves compression
produces headache, vertigo, hearing loss with tinnitis and
blindness.
⚫Other manifestations,i.e., fatigue,
lethargy,hyperparathyroidism with renal or urinary stones.
DIAGNOSIS
Serum calcium is usually normal except with generalized disease.
Alkaline phosphate is elevated.
X-ray of the skull may show large skull with flattening of the base
skull(platybasio). X-ray of spine and legs may show deformities and a
characteristic mosaic pattern(a mix of bone absorption and formation).
Audiometry may reveal conductive or nerve deafness.
Nerve conduction velocities may reveal nerve compression.
Bone scan.
COMPLICATIONS
Fractures(abnormal bone).
Osteogenic sarcoma.
Neuromuscular syndromes (compression).
Joint disease(degenerative).
Cardiovascular abnormalities (hyper-dynamic
circulation)
MANAGEMENT
Asymptomatic patients do not require treatment.
Thetreatment of Paget’s disease is symptomatic,
supportive and correction of deformities by braces or
surgery.
MEDICAL
MANAGEMENT
Bisphosphonates are required to reduce the osteoclastic
activity.
Calcium+ vitamin D+ sunshine and exercises.
The osteoclastic/osteoblastic activity can be monitored by
regular check up of serum/urinary calcium, bone specific
alkaline phosphatases.
Needs management of cardiac problems due to hyper-dynamic
circulation.
Watch for osteogenic sarcomas.
NURSING MANAGEMENT
Implementation of nutritional program.
Providing medications as advised and monitor the
response with investigations.
Nurse teaches the client about the use of assist device
and environmental changes to be pursued to prevent
falls and subsequent fractures.
SURGICAL
MANAGEMENT
Help fractures heal.
Replace joints damaged by severe arthritis.
Realign deformed bones.
Reduce pressure on nerves.
NURSING DIAGNOSIS
Acute pain related to bone fracture.
Impaired physical mobility related to disease process.
Anxiety related to disease process.
Risk for infection related to surgical procedure.
Riskfor GIT ulcer related to effect of the prescribe
medication.
Body image depict related to disease process.
HEALTH EDUCATION
Intake of vitamin D rich foods help in preventing and managing
Paget’s disease.
Light exercise such as Yoga and flexibility practice are
beneficial in preventing Paget’s disease.
Exposure to sunlight helps to prevent and treat Paget’s disease.
Avoid any and all high-impact activities.
Increase intake of foods rich in calcium.
Weight loss helps in reducing stress on bones and joints.
SUMMARY
Introduction
Definition
Incidence
Causes
Pathophysiology
Clinical manifestation
Diagnosis
Complications
Management
Nursing diagnosis
Health education.
CONCLUSION
Atthe end of this planned lesson plan, I would like to
give thanks to Suman sir for his guidance who helped
me to gain knowledge and confidence regarding my
topic Paget’s disease.
