Pagets disease

Paget's disease of bone is a common metabolic bone disease common in Europe but rare in Asia. We report Paget's disease in an 80 years old male who presented with an implant failure following an IM nailing of the left femur. Plain X-ray raised suspicion of Paget's disease of bone. Even though the technetium bone scan showed involvement of multiple bones the alkaline phosphatase was normal. Bone biopsy done during the exchange nailing confirmed the diagnosis. The authors emphasizes need to identify the disease early in order to avoid complications and need to start bisphosphonates before performing a surgery even in the setting of normal alkaline phosphatase values