Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Reason for Visit:
Follow-up for diagnosed Paget’s disease
Evaluation of new or worsening bone pain
Assessment for complications (fractures, deformity)
Monitoring response to treatment
History of Present Illness:
Onset, duration, and severity of bone pain (location,
pen_spark
character).
Previous fractures or history of falls.
Any new symptoms suggestive of complications (e.g., joint deformity,
hearing loss).
Current medications for Paget’s disease and any side effects.
Past Medical History:
Underlying medical conditions (e.g., arthritis, osteoporosis).
Previous surgeries (relevant surgeries on affected bones).
Family History:
Family history of Paget’s disease (rare).
Social History:
Occupation and impact of pain on daily activities.
Use of tobacco products or alcohol (may worsen bone health).
Physical Examination:
General examination: Assess for signs of bone deformity or
arthropathy
(joint disease) in affected areas.
Musculoskeletal examination: Palpate for tenderness, warmth,
and
decreased range of motion in affected joints. May also assess for
obvious
deformity.
Neurological examination (if indicated): May be necessary if
hearing loss is suspected as a complication.
Diagnostic Tests (if indicated):
Imaging studies:
X-rays: May show characteristic changes in affected bones
(enlarged,
coarsened trabecular pattern).
Bone scan: Can help identify the extent of involvement and
activity of Paget’s disease.
Laboratory tests:
Serum alkaline phosphatase (ALP) level: Elevated levels
are
suggestive of Paget’s disease activity.
Calcium and phosphate levels: May be abnormal in some cases.
Assessment:
Paget’s disease: Based on clinical presentation (bone pain,
physical examination findings) and supported by diagnostic testing
(imaging and laboratory results).
Extent of involvement: Identify which bones are affected by Paget’s
disease.
Activity of disease: Consider the severity of symptoms, laboratory
findings (ALP level), and imaging results to assess the current activity
of Paget’s disease.
Potential complications: Evaluate for fractures, arthropathy,
and
hearing loss (less common).
Differential Diagnoses:
Consider other conditions that may mimic Paget’s disease:
Metastatic bone disease (cancer spread to bone)
Osteoporosis
Fibrous dysplasia (benign bone tumor)
Plan:
Treatment plan: Depends on the severity and activity of Paget’s disease,
presence of complications, and patient factors. Treatment may include:
Bisphosphonates: Medications that inhibit bone resorption
(breakdown) and can help reduce bone pain and slow disease progression.
Denosumab: Another medication that inhibits bone resorption.
Calcitonin: Hormone that can help reduce bone pain.
Pain management: Medications to manage bone pain and improve
quality of life.
Surgery (rare): May be considered for severe complications
such as
fractures or joint deformity.
Monitoring: Regular follow-up appointments with monitoring of symptoms,
laboratory tests (ALP), and imaging studies (if needed).
Patient education: Educate the patient about Paget’s disease,
symptoms, treatment options, and importance of regular follow-up.
Referral to specialists (if indicated): Referral to an orthopedic
surgeon may be necessary for management of fractures or severe deformity.
Prognosis:
Paget’s disease is a chronic condition, but treatment can improve bone
health and reduce pain. Early diagnosis and management are crucial to
prevent complications.