Paget Disease of the Mandible

Abstract

Objective: Paget disease of the bone is a common disorder of bone metabolism characterized by increased bone turnover and abnormal bone architecture. Paget disease may be monostotic or polyostotic. Herein, we describe the clinical course of an elderly patient who presented with jaw pain and was found to have monostotic disease of the anterior mandible. Methods: An 81-year-old male presented to our endocrinology clinic for an evaluation at the request of his oral surgeon. The patient reported that for the preceding 6 months, he had been suffering from jaw pain and gradual inability to eat solid foods. He was also suffering from hearing loss. Results: Lab work showed a calcium of 8.6 mg/dL (normal range, 8.7 to 10.7 mg/dL), albumin of 3.5 g/dL (normal range, 3.5 to 4.8 g/dL), and a bone-specific alkaline phosphatase of 45.5 μg/L (normal range, 7.6 to 14.9 μg/L). Computed tomography scan of maxillofacial bones showed that the mandible had diffuse areas of cortical and trabecular thickening. Biopsy from the anterior mandible revealed fragments of bone with irregular, thickened trabecula with bluish cement lines, consistent with Paget disease. Conclusion: While Paget disease of the jaw is a radiologic diagnosis, a biopsy of the bone may be necessary to establish the diagnosis and to exclude any infectious pathology or oncologic transformation. Intravenous zoledronic acid is the drug of choice for treatment, and remission can be monitored clinically as well as biochemically. Abbreviations: Bs-ALP = bone-specific alkaline phosphatase;CTx = C-telopeptide;NTx = N-telopeptide;PDB = Paget disease of the bone