Paget Disease of Bone N007

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Current RMA Instruments

Changes from previous instruments

ICD Coding

ICD-10-AM Code: M88

Brief description

This chronic bone disorder involves abnormal bone remodelling.  This means that there is initially an excessive breakdown of bone tissue followed by the formation of bone tissue that is structurally disorganised and weaker than normal bone.  It can occur at a single or multiple sites.  The commonly affected areas include the skull, spine, pelvis and long bones of the leg.  Individuals may experience bone pain, joint stiffness or fractures.  If the skull is affected, headaches and hearing loss may also be reported.  Some people report no symptoms at all despite deformity, bowing or enlargement of the bones. 

Confirming the diagnosis

Diagnosis usually requires X-rays showing a characteristic appearance.  Blood tests measuring markers of bone turnover can also help to 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.