Case history
Case history #1
A 55-year-old man complains of persistently aching legs. He is initially diagnosed with fibromyalgia. However, his blood tests reveal an elevated serum alkaline phosphatase. Subsequent x-ray of the tibia and fibula shows defects in the cortical and cancellous bone, with some degree of tibial bowing, leading to a revised diagnosis of PDB.
Case history #2
A late middle-aged woman presents with chronic right hip and anterior thigh pain, with increased localised temperature. Lately she has needed a walking stick. During the past 6 months her relatives have noticed a progressive hearing loss on her left side, as well as some facial changes - mostly enlargement of her mandible.
Other presentations
PDB is asymptomatic in most patients, and it is usually diagnosed by incidental findings on x-ray or elevated serum alkaline phosphatase.[3]
Rarely, PDB is associated with the development of osteosarcoma, a malignant tumour of the bone. When there is a sudden onset or worsening of chronic pain, osteosarcoma should be considered.
PDB affecting the facial bones may present with teeth becoming loose and associated chronic facial pain. Disturbance in chewing may occur. Osteoporosis, which shares the same age population, may occur concomitantly. PDB is only rarely encountered in the hands or feet.
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