DRG Category: 553

Mean LOS: 5.7 days

Description MEDICAL: Bone Disease and Arthropathies with Major CC

classification section:



Paget's disease, or osteitis deformans, is a slowly progressing condition of bone structure characterized by increased and disorganized bone turnover. It affects approximately 4% of the U.S. population older than 40 years. The bones affected vary, but those most commonly involved are the femur, tibia, lower spine, pelvis, and skull. Initially, there is an increase in the number of osteoclasts, which leads to excessive bone resorption and a compensatory increase in osteoblastic activity to repair bone matrix. As a result, the bone is enlarged and distorted, with areas of poor mineralization that resemble a mosaic pattern. Consequently, the bone cannot adequately withstand stresses and strains and is weaker.

Paget's disease causes bones to fracture easily, often after only a minor trauma; these fractures heal slowly and often incompletely. If the spine is involved, the vertebrae may collapse, causing paraplegia. If the skull is involved, bony impingements on the cranial nerves can lead to blindness, hearing loss, tinnitus, or vertigo. Other complications of Paget's disease include osteoarthritis, hypocalcemia, renal calculi, bone sarcoma, hypertension, and gout. The disease is most life threatening when it is combined with congestive heart failure because of the need for increased cardiac output to supply increased blood flow to the bones.