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  Diagnosing Paget's Disease of Bone  


Many patients who have Pagetís disease of bone do not know that they have it, since the disease may be so mild that it is not detected. Sometimes, the patientís doctor is alerted to the possibility of Pagetís disease when a blood test reveals an elevated level of serum alkaline phosphatase (SAP).† Sometimes the patientís symptoms are confused with arthritis or other disorders. In other cases, the diagnosis is made only after complications have developed.


Q. What is SAP?


A. SAP is a chemical (enzyme) that is produced by bone cells and is over-produced by Pagetic bone. SAP is measured by using a routine blood test.† A SAP level that is higher than normal, provided that there is no evidence of liver disease, probably indicates that the source of elevated SAP is bone rather than some other part of the body.† A mild increase in SAP level (up to twice the normal level) might indicate Pagetís disease or another problem, such as a healing fracture.† A SAP level two or more times higher than normal strongly suggests Pagetís disease, especially if serum calcium and phosphorus, as well as renal (kidney) function, are normal.


The range of SAP that is considered normal varies considerably depending on the laboratory used for the test. A typical ďnormalĒ range for a person over the age of 60 may range from 20-120 units.


In addition to its use in diagnosis, measurement of SAP is an important tool for monitoring a patientís response to therapy for Pagetís disease. In some patients it may be necessary to measure the serum bone alkaline phosphatase, using a special test which is helpful in assessing bone disease in patients with abnormal liver function. In some cases urinary markers of bone resorption such as N-telopeptide are also used to monitor the response the treatment.



Q. What is a bone scan and how is it used to diagnose Pagetís disease?


A. A bone scan is another way to identify bones affected by Pagetís disease. When a bone scan is performed, a safe amount of a radioactive substance is injected and circulates through the bloodstream, showing areas of the skeleton where Pagetís disease might be present.



Q. How are X-rays used to diagnose Pagetís disease?


A. X-rays are used alone or in conjunction with bone scans to confirm or eliminate the presence of Pagetís disease. Bones affected by Pagetís disease have a characteristic appearance on x-rays.


Q. When may a bone biopsy be used to diagnose Pagetís disease?


A.Rarely, a bone biopsy may be required if the x-ray is not conclusive.



Summary:† Key factors for diagnosing Pagetís disease are an elevated SAP and an x-ray showing pagetic bone.





For additional information, contact:


The Paget Foundation

120 Wall Street, Suite 1602

New York, NY 10005-4001

Tel (800) 23-Paget or (212) 509-5335

Fax (212) 509-8492




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