A Case of Paget's Disease with Scapula Involvement

Abstract

Paget's disease is a common bone disorder which is characterized by excessive bone turnover. This condition rarely involves sternum, patella, scapula, hand, foot and facial bones. A 65-year-old male patient was admitted to our outpatient clinic with the complaint of right-sided pain that radiated from his groin to his knee for the last 5-6 years. His physical examination revealed limited hip movements and pain. Whole body bone scintigraphy detected diffuse, increased activity in the right coxa and entire scapula. Elevated alkaline phosphatase (ALP) ( 367 U/L) was observed in laboratory results. Further investigations and examinations were performed in order to exclude possible malignancies (eg. prostate, lung) due to involvement of scapula which is atypical for Paget's disease. Finally, poliostotic Paget's disease with pelvic and scapular involvement was considered as the definite diagnosis. Treatment with risedronate sodium was started at a dose of 35 mg daily which led to marked improvement in hip pain and reduction in ALP level to 150 U/L after one month. While making a differential diagnosis of scintigraphic lesions at an unusual location such as scapula, consideration should be given to the fact that Paget's disease may affect any bone in the body although this is rare.