The cases of five patients with the predominantly osteolytic form of
Paget's disease affecting weight-bearing long bones are described. The
diagnosis was not recognized initially in three. In two of them a biopsy
was performed, and one subsequently had a fracture through the biopsy site
more than a year later. In all five, calcitonin treatment was effective in
restoring the bone architecture toward normal as determined
radiographically. Relapse occurred in two patients shortly after the
cessation of calcitonin treatment and in a third despite continued
treatment. The flame-shaped resorption from of the osteolytic component of
Paget's disease has a pathognomonic appearance radiographically.
Radionuclide bone-scanning can help in establishing the diagnosis.
Diagnostic biopsy of such an area, particularly in a weight-bearing long
bone, is unnecessary and should be avoided because of the increased risk of
fracture.