osteopetrosis v Paget

[Qester]

Hello,

I have managed to confuse myself with osteopetrosis and paget disease, how to differentiate them etc..

I had a question where the explanation said that the lab values for both are the same, normal Ca/Phos with elevated Alk Phos, and to tell the difference primarily was age, with Paget in older and osteopetrosis in a younger population.

First aid however shows Osteopetrosis primarily as having completely normal labs, with Paget having an elevated alk phos.

Can anyone explain these disease, differences in clinical presentation (if any) and how to diagnosticlaly tell the difference for step 1?

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[slz1900]

Osteopetrosis is caused by a global defect in osteoclasts. Osteoblast function is unopposed, so there is excess bone formation. Alk phos will usually be normal/high normal since the defect is not with the osteoblasts and they are the source of ALP. TRAP and CK-BB are elevated (not sure how high yield that is though).

Paget's is caused by increased osteoclast function followed by osteoclast burnout. It can be more localized than osteopetrosis, although it can also be systemic. Because there is osteoclast destruction followed by osteoblast remodeling, the bone is disorganized and has a mosaic appearance. Alk phos is elevated since osteoblast activity surges (that doesn't happen in osteopetrosis where osteoblasts are functioning at normal levels but are unopposed). Paget's is also pre-malignant, while osteopetrosis is not. If there is an isolated increase in ALP, it is Paget's.

 

[Qester]

Osteopetrosis is caused by a global defect osteoclasts. Osteoblast function is unopposed, so there is excess bone formation. Alk phos will usually be normal/high normal since the defect is not with the osteoblasts and they are the source of ALP. TRAP and CK-BB are elevated (not sure how high yield that is though).

Paget's is caused by increased osteoclast function followed by osteoclast burnout. It can be more localized than osteopetrosis, although it can also be systemic. Because there is osteoclast destruction followed by osteoblast remodeling, the bone is disorganized and has a mosaic appearance. Alk phos is elevated since osteoblast activity surges (that doesn't happen in osteopetrosis where osteoblasts are functioning at normal levels but are unopposed). Paget's is also pre-malignant, while osteopetrosis is not. If there is an isolated increase in ALP, it is Paget's.

Thank you!

 

[mulberry]

Random tidbit but urinary hydroxyproline would be elevated in Paget's. Not sure if this is high yield or not.