Question of the Week # 155

155)  A 55 year old man presents to the clinic for progressive right hip pain. He has a history of hearing impairment. He reports pain in the right hip when walking more than 1 block and also, has difficulty putting shoes on his right foot. On examination, the range of motion is significantly limited in the right hip. An X-ray of the right hip reveals significant loss of cartilage, subchondral sclerosis and sub-chondral cysts. X-ray also reveals pagetoid changes in the right iliac wing and right femoral neck. Serum alkaline phosphatase level is 432 IU/L (n = 20 to 140 IU/L). The most appropriate initial step in managing this patient is:

A)           Bisphosphanates

B)            Acetaminophen

C)            Bisphosphanates and Acetaminoiphen

D)           Calcitonin Intranasally

E)           Oral prednisone

4 Responses

  1. B

  2. c, pt has pagets disease as alkaline phosp.is elevated its mainstay of tm is oral bisphosphonates plus acetaminophen can be added

  3. Paget’s disease can cause pain in the bones or joints, headaches and hearing loss, pressure on nerves, increased head size, bowing of limb, or curvature of spine

  4. C

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