Here's a pelvic radiograph. 78-year old male with pain.

There are coarse trabeculae with cortical thickening, and enlarged pelvic bones. The rest of his skeleton was unremarkable except for vertebral osteopaenia and compression fractures. There's a pathological fracture of the inferior right acetabular rim. Findings are likely related to Paget's disease. His alkaline phosphatase was normal.

The pelvis and femur are common sites for Paget's. Strange places for Paget's to present include monostotic Paget's of the patella and also the fingers!


The high bone turnover that characterises this syndrome accounts for increased alkaline phosphatase (but not always raised). Vascular steal syndromes of the skull and vertebrae can result in somnolence, and compression fractures. Bony overgrowth leads to accelerated osteoarthritis, and nerve impingement (such as loss of hearing). And the dreaded complication of osteo or even chondrosarcomas must be looked out for (under 1% of patients). Pathological fractures are a frequent complication and may be the presenting feature, with a reported incidence of between 10% and 30%

It's easy to forget the tentative link Paget's has with bird ownership (paramyxovirus).

Forestier's disease, or disseminated idiopathic hyperostosis (DISH), may affect patients with PD, and should not be confused with focal Pagetic bone formation.