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PAGET'S BONE DISEASE

Paget's bone disease, also known as osteitis deformans, is characterized by a significant increase in bone resorption and turnover in localized parts of the skeleton causing enlargement and thickening of the bone that is disordered and architecturally unstable.
The prevalence increases with age, with men and women affected equally.
Genetic factors and/or viral infection may play a role in the etiology.
May affect one bone (monostotic) or several bones (polyostotic).
By decreasing frequency, involved bones may include pelvic bone and sacrum, spine, skull and femur, tibia, humeri and clavicles.

Paget's%20bone%20disease Management

Management

Follow Up

Frequency and extent of follow-up will depend upon severity of disease

Monitor serum alkaline phosphatase (ALP) every 3-6 months to determine the biochemical response to bisphosphonate therapy
- Once the value of serum ALP plateaus after 3-6 months of assessment, it can be measured 1-2x/year as a marker of bone activity

A more specific bone formation/resorption marker other than ALP (ie amino-terminal propeptide of type 1 collagen [P1NP], βC-terminal propeptide of type-1 collagen [βCTx], N-terminal propeptide of type 1 collagen [NTx] assay) may be measured for patients with untreated monostotic Paget’s disease
Serial imaging tests (eg bone scan) are not generally useful in routine monitoring of treatment response
- Bone scan may be helpful in monitoring treatment response after 6-12 months of treatment in patients with monostotic disease

If treatment failure is apparent consider re-treatment 6 months after the initial therapy for the following:
- Symptom relapse or persistence
- >25% above nadir of serum ALP in asymptomatic patient

Long-term evolution increases the risk for osteosarcoma on pagetic bone

Spotlight on multidrug-resistant gram-negative infections: New developments for an old problem

Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021

Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.