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KMID : 1100120200270010071
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대한골대사학회지
2020 Volume.27 No. 1 p.71 ~ p.75
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Paget's Disease of Bone Affecting Peripheral Limb: Difficulties in Diagnosis: A Case Report
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Lee Jun-Ku
Kang Yun-Kyung
Wang Pei Wei
Hong Soo-Min
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Abstract
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In terms of management of Paget's disease of bone (PDB), early diagnosis and proper management achieving remission is essential with lifelong specialist follow-up. We present the case of a 40-year-old woman with PDB affecting mainly the distal extremities (ankle and wrist). The patient visited our hospital in 2012 with heel pain. Plain radiography revealed osteoporosis, and a bone scan revealed hot uptake. Initial laboratory investigations showed normal serum calcium, 25-hydroxy-vitamin D, and parathyroid hormone levels; however, osteocalcin, C-terminal telopeptide of type I collagen, and bone alkaline phosphatase levels were elevated. A bone mineral density scan showed T- and Z-scores of ?2.5 and ?2.7, respectively, and bisphosphonate treatment was initiated. Biopsy performed on the calcaneal lateral wall revealed inconclusive findings. Follow-up biopsy on the left distal radius was performed 7 years later to investigate wrist pain, and this examination led to a final diagnosis as PDB. We suggest inconclusive biopsy result during the early phase of PDB and highly recommend follow-up evaluation in osteoporosis with atypical behavior.
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KEYWORD
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Alkaline phosphatqse, Biopsy, Diphosphonates, Osteitis deformans
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