Paget's Disease

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Paget's disease of bone is a common disease of unknown cause affecting bones in the elderly.

In Paget's disease there is excessive uncontrolled resorption of bone by large abnormal multinucleated osteoclasts.
Excessive osteoclastic erosion occurs in waves, leading to localized destruction of trabecular and cortical bone; each wave of bone destruction is followed by a vigorous but uncoordinated osteoblastic response, producing new osteoid in an attempt to fill the defects left by the osteoclasts.
Both the osteoclastic erosion and the osteoblastic response are random, haphazard and unrelated to the functional stresses on the bone. As a result, the bone architecture is greatly distorted and, although there may be an increase in bone bulk, it is paradoxically weaker than normal. New bone formed as a repair attempt by the osteoblasts often has the characteristic woven, non-lamellar pattern indicative of rapid reparative deposition. Disruption of the bone architecture is followed by progressive fibrosis of the marrow spaces.

Paget's disease may be widespread, affecting many bones, or confined to one area in a single bone (monostotic Paget's disease). Its cause is unknown, but a viral infection of osteoclasts has been postulated because of the observation that some abnormal osteoclasts in Paget's disease contain paracrystalline inclusions resembling paramyxovirus. However, no virus has been shown using sophisticated molecular techniques.
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