Year: 2026 | Month: July-September | Volume: 11 | Issue: 3 | Pages: 300-309
DOI: https://doi.org/10.52403/ijshr.20260333
Polyostotic Paget’s Disease of Bone Involving the Pelvis and Lumbar Spine in A 78-Year-Old Female: A Case Report
Ashutosh Yadav1, Pushpa2, Sachin Kumar3
1Senior Resident, Department of Orthopaedics, Maharishi Chyawan Government Medical College, Koriawas, Narnaul, Haryana, India
2Assistant Professor, Department of Anaesthesia, Maharishi Chyawan Government Medical College, Koriawas, Narnaul, Haryana, India
3Senior Resident, Department of Orthopaedic Surgery, Balrampur Hospital, Golaganj, Lucknow, Uttar Pradesh, India
Corresponding Author: Dr. Ashutosh Yadav
ABSTRACT
Background: Paget’s disease of bone (PDB) is a chronic, focal disorder of bone remodelling characterised by disorganised osteoclastic resorption followed by exuberant, structurally abnormal bone formation. It typically affects individuals over 55 years of age and is comparatively uncommon in the Indian subcontinent, where it may be under-recognised.
Case Report: A 78-year-old female presented with insidious-onset, progressive low back pain of 18 months’ duration with difficulty in ambulation. Radiographs of the pelvis and lumbosacral spine showed a coarsened, disorganised trabecular pattern with mixed lytic and sclerotic areas involving both iliac bones and the pubic rami, thickening of the iliopectineal line, cortical thickening, and a “picture-frame” appearance of the lumbar vertebrae. Serum alkaline phosphatase (ALP) was markedly elevated at 684 IU/L (reference 40-129 IU/L) with normal calcium, phosphate and parathyroid hormone, and secondary causes of osteosclerosis were excluded. Technetium-99m MDP bone scintigraphy confirmed a polyostotic distribution. Following correction of vitamin D status, she received a single intravenous infusion of zoledronic acid 5 mg with analgesia and supervised physiotherapy. At 6 months, pain had improved from a visual analogue scale score of 8/10 to 3/10 and serum ALP had fallen to 198 IU/L.
Conclusion: PDB should be considered in elderly patients with chronic skeletal pain and mixed lytic-sclerotic radiographic changes. Characteristic radiological signs with an elevated ALP and normal calcium and phosphate permit accurate non-invasive diagnosis in most cases, and timely bisphosphonate therapy relieves symptoms and substantially reduces bone turnover.
Keywords: Paget’s disease of bone, osteitis deformans, bone remodelling, zoledronic acid, alkaline phosphatase, case report