How does Paget's disease differ from osteoporosis?

Monitoring serum calcium levels is important during bisphosphonate therapy for Paget's disease. Bisphosphonates can affect calcium metabolism, and monitoring calcium levels helps ensure appropriate dosing and prevent complications such as hypocalcemia or hypercalcemia.

a. Liver function tests (LFTs): Bisphosphonates generally do not have a significant impact on liver function. Monitoring LFTs is not a primary concern during bisphosphonate therapy.

c. Blood glucose levels: Bisphosphonate therapy is not known to affect blood glucose levels. Monitoring blood glucose is not directly related to Paget's disease treatment.

d. Complete blood count (CBC): Bisphosphonate therapy does not typically have a major effect on blood cell counts. Monitoring a CBC is not a primary concern during bisphosphonate treatment for Paget's disease.

The underlying pathophysiology of Paget's disease involves increased bone turnover and disordered bone remodeling. Osteoclasts, the bone-resorbing cells, become overactive, leading to excessive bone resorption. Osteoblasts, the bone-forming cells, attempt to repair the resorbed bone, but their activity is disordered, resulting in the formation of structurally abnormal bone.

a. Decreased bone density due to calcium deficiency: This is the pathophysiology of osteoporosis, not Paget's disease. In Paget's disease, bone density can be normal or increased due to the disordered bone remodeling.

c. Excessive collagen production leading to bone deformities: Excessive collagen production is not a characteristic feature of Paget's disease. The condition primarily involves abnormal bone remodeling by osteoclasts and osteoblasts.

d. Autoimmune attack on osteoblasts causing bone destruction: Paget's disease is not an autoimmune disorder. The disease is characterized by increased bone resorption and disordered bone formation, not an immune-mediated attack on osteoblasts.