Monostotic osteitis deformans of lumbar vertebra: A rare phenomenon in Eastern Asia
Arun-Kumar Kaliya-Perumal1, Michael Jian-Wen Chen2, Chi-Chien Niu2, Po-Liang Lai2
1 Department of Orthopaedic Surgery, Spine Division, Bone and Joint Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Orthopaedics, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Melmaruvathur, Tamil Nadu, India
2 Department of Orthopaedic Surgery, Spine Division, Bone and Joint Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
Department of Orthopaedic Surgery, Spine Division, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan, Taoyuan 33305
Source of Support: None, Conflict of Interest: None
Osteitis deformans, also known as Paget's disease, is characterized by accelerated osteoclastic activity followed by ineffective osteoblastic activity resulting in a deformed and fragile bone. It is more prevalent in Western Europe and relatively rare in Eastern Asia. It predominantly involves the lumbar spine, pelvis, and femur, frequently as polyostotic and rarely as monostotic disease. Here, we report a 64-year-old female, who presented with severe progressive back pain with no neurological symptoms. Radiographs revealed a picture frame L1 vertebra which was deformed and enlarged with loss of normal alignment. Magnetic resonance imaging revealed bone marrow changes involving all columns of L1 vertebra. Whole-body technetium-99 bone scan showed a solitary increased uptake of radioisotope by L1 vertebra. Considering the possibility of metastatic tumors, blood investigations were drawn for tumor markers which were within normal limits. A computed tomography-guided biopsy was done to facilitate diagnosis. Histopathology sections showed a mosaic pattern of bony trabeculae with multinucleated osteoclasts causing erosions and tunneling. A diagnosis of monostotic Paget's disease was made which satisfactorily responded to single-dose zoledronic acid treatment. A comprehensive literature review is provided.