When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Doença de Paget óssea

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 22 Aug 2025
Last updated: 01 Sep 2022

Summary

Definition

History and exam

Key diagnostic factors

  • história familiar de DPO
  • assintomático
Full details

Other diagnostic factors

  • comprometimento do fêmur, da pelve e/ou do crânio
  • dor no osso longo ou dorsalgia
  • fratura patológica
  • deformidades ósseas (por exemplo, bossa frontal, prognatismo, arqueamento ósseo)
  • temperatura local elevada
  • perda auditiva
  • dor facial
  • dentes frouxos ou distúrbio da mastigação
  • fosfatase alcalina elevada isolada
Full details

Risk factors

  • história familiar de DPO
  • idade >50 anos
  • sexo masculino (faixa etária dos 45 a 74 anos)
Full details

Diagnostic investigations

1st investigations to order

  • radiografia simples
  • cintilografia óssea
  • fosfatase alcalina sérica total
  • fosfatase alcalina ósseo-específica
  • cálcio sérico
  • peptídeo N-terminal do procolágeno sérico 1 (P1NP)
  • propeptídeo C-terminal sérico do colágeno do tipo1 (CTX)
  • testes da função hepática
  • 25-hidroxivitamina D sérica
Full details

Investigations to consider

  • tomografia computadorizada (TC) ou ressonância nuclear magnética (RNM)
  • biópsia dos ossos
Full details

Treatment algorithm

ONGOING

pacientes assintomáticos, diagnóstico incidental

pacientes sintomáticos

Contributors

Authors

Roberto Civitelli, MD

Sydney M. & Stella H. Schoenberg Professor of Medicine

Professor of Orthopaedic Surgery and Cell Biology and Physiology

Chief, Division of Bone and Mineral Diseases

Musculoskeletal Research Center

Washington University School of Medicine

St. Louis

MO

Disclosures

RC is Editor-in-Chief of the Journal of Bone and Mineral Research (position ending 31/12/2022).

Mahshid Mohseni, MD, MSci

Assistant Professor

Director, Clinical Research Unit

Co-Director, Clinical Operations

Division of Bone and Mineral Diseases

Department of Medicine

Washington University School of Medicine

St. Louis

MO

Disclosures

MM declares that he has no competing interests.

Acknowledgements

Dr Roberto Civitelli and Dr Mahshid Mohseni would like to gratefully acknowledge Dr Julia F. Charles, Dr Camilo Restrepo, and Dr Javad Parvizi, previous contributors to this topic.

Disclosures

JFC has received royalties from Up To Date, Waltham, MA, for authorship on articles relating to PDB; received grant funding from the National Institues of Health, the Rheumatology Research Foundation, and Brigham and Women's Hospital for research into regulation of osteoclast function, but not specifically relating to PDB; and had a manuscript published from a collaboration with Dr Jae Shim describing a pagetic phenotype in mice with osteoclast-specific loss of Chmp5. CR and JP are authors of a reference cited in this topic.

Peer reviewers

Frederick Singer, MD

Director

Endocrine/Bone Disease Program

John Wayne Cancer Institute

Santa Monica

CA

Disclosures

FS declares that he has no competing interests.

Joseph Lane, MD

Orthopaedic Surgeon

Hospital for Special Surgery

New York

NY

Disclosures

JL declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Tuck SP, Walker J. Adult Paget's disease of bone. Clin Med (Lond). 2020 Nov;20(6):568-71.Full text  Abstract

Singer FR, Bone HG 3rd, Hosking DJ, et al. Paget's disease of bone: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2014 Dec;99(12):4408-22.Full text  Abstract

Whitehouse RW. Paget's disease of bone. Semin Musculoskelet Radiol. 2002 Dec;6(4):313-22. Abstract

Ralston SH, Corral-Gudino L, Cooper C, et al. Diagnosis and management of Paget's disease of bone in adults: a clinical guideline. J Bone Miner Res. 2019 Apr;34(4):579-604.Full text  Abstract

Cooper C, Dennison E, Schafheutle K, et al. Epidemiology of Paget's disease of bone. Bone. 1999;24:3S-5S. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Use of this content is subject to our disclaimer