Last reviewed: 25 Aug 2021
Last updated: 29 Jan 2019



History and exam

Key diagnostic factors

  • family history of Paget 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

  • family history of Paget 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

Treatment algorithm



Julia F. Charles, MD, PhD

Associate Physician

Assistant Professor of Medicine

Brigham and Women's Hospital

Department of Orthopaedics and Medicine/Rheumatology




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 would 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

Frederick Singer, MD


Endocrine/Bone Disease Program

John Wayne Cancer Institute

Santa Monica



FS declares that he has no competing interests.

Joseph Lane, MD

Orthopaedic Surgeon

Hospital for Special Surgery

New York



JL declares that he has no competing interests.

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