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Paget's Disease of Bone N007

Document
Last amended 
12 November 2019
Current RMA Instruments
Reasonable Hypothesis SOP
49 of 2015
Balance of Probabilities SOP
50 of 2015
Changes from previous instruments

SOP Bulletin 181

ICD Coding
  • ICD-9-CM Codes: 731.0
  • ICD-10-AM Codes: M88
Brief description

This is an idiopathic disorder of bone.  It involves bone remodelling, with overgrowth of bone and a weakening of the bone structure.  It can occur at a single or multiple sites.  Commonly affected areas include the skull, spine, pelvis and long bones of the leg.

Confirming the diagnosis

Diagnosis usually requires X-rays showing a characteristic appearance.  Blood and urine tests can also help confirm the diagnosis.  Bone scans can show the extent of the disease.

The relevant medical specialist is an endocrinologist, rheumatologist or orthopaedic surgeon.

Additional diagnoses covered by SOP
  • Osteitis deformans
Conditions excluded from these SOPs
  • Osteomyelitis*
  • Osteopaenia - not a disease or injury (RMA declaration)
  • Osteoporosis*
  • Paget’s disease of the breast*  - Malignant neoplasm of the breast SOP

* another SOP applies

Clinical onset

Onset is typically after age 55. It is most often asymptomatic and detected incidentally following imaging performed for another indication, or from routine blood chemistry showing an elevated serum alkaline phosphatase concentration. Symptoms can include pain and deformity at the affected site. 

Clinical worsening

The only SOP factor is for inability to obtain appropriate clinical management.  Effective drug therapies are available that can alter the course of the disease.  Treatment is indicated for symptomatic disease and in asymptomatic patients with biochemical abnormalities or imaging changes that indicate a risk of complications.