What are the key clinical features that suggest a diagnosis of Paget's disease of bone in a patient?

Key clinical features suggesting a diagnosis of Paget's disease of bone include:

• Bone pain, which is often the most common presenting symptom and may be localized or diffuse.
• Bone deformities such as bowing of long bones or skull enlargement, reflecting abnormal bone remodeling.
• Increased warmth over affected bones due to increased vascularity.
• Pathological fractures occurring with minimal trauma, indicating weakened bone structure.
• Neurological symptoms such as hearing loss or nerve compression syndromes if the skull or spine is involved.
• Asymptomatic cases detected incidentally by elevated serum alkaline phosphatase or characteristic radiological findings.

These features arise from the focal areas of increased and disorganized bone turnover characteristic of Paget's disease, which can affect one or multiple bones. Diagnosis is supported by biochemical markers and imaging but clinical suspicion is raised primarily by the above signs and symptoms.

(Tan and Ralston, 2014; Lalam et al., 2016; Gennari et al., 2019)¹