Last reviewed: September 2018
Last updated: December  2017



History and exam

Key diagnostic factors

  • FHx of Paget's disease
  • asymptomatic

Other diagnostic factors

  • femoral, pelvis, and/or skull involvement
  • long-bone or back pain
  • pathological fracture
  • bony deformities (e.g., frontal bossing, prognathism, bone bowing)
  • increased local temperature
  • hearing loss
  • facial pain
  • loosening teeth or disturbance in chewing
  • deterioration of visual acuity

Risk factors

  • FHx of Paget's disease
  • age >50 years
  • male sex (45- to 74-years age group)
  • infection
  • environmental factors

Diagnostic investigations

1st investigations to order

  • plain x-ray
  • bone scan
  • total serum alkaline phosphatase
  • bone-specific alkaline phosphatase
  • serum calcium
  • serum procollagen 1 N-terminal peptide (P1NP)
  • serum C-terminal propeptide of type 1 collagen (CTX)
  • LFTs
  • serum 25-hydroxyvitamin D
Full details

Investigations to consider

  • CT scan or MRI
  • bone biopsy
Full details

Treatment algorithm


Authors VIEW ALL

Associate Physician

Instructor in Medicine

Brigham and Women's Hospital

Rheumatology Division




JFC has received royalties from Up To Date, Waltham, MA, for authorship on articles relating to Paget disease of bone (PDB). JFC has also received grant funding from the NIH, Rheumatology Research Foundation and Brigham and Women's Hospital for research into regulation of osteoclast function, but not specifically relating to PDB. JFC has had a manuscript published from a collaboration with Dr. Jae Shim describing a Pagetic phenotype in mice with osteoclast-specific loss of Chmp5.

Dr Julia F. Charles could like to gratefully acknowledge Dr Camilo Restrepo and Dr Javad Parvizi, previous contributors to this topic. CR and JP are authors of references cited in this topic.

Peer reviewers VIEW ALL


Endocrine/Bone Disease Program

John Wayne Cancer Institute

Santa Monica



FS declares that he has no competing interests.

Orthopaedic Surgeon

Hospital for Special Surgery

New York



JL declares that he has no competing interests.

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