A 48yo man presents with bone pain. Labs: ALP=high, phosphate=normal. What is the most likely dx?

A 48yo man presents with bone pain. Labs: ALP=high, phosphate=normal. What is the most

likely dx?

a. Osteoporosis

b. Osteomalacia

c. Paget’s disease

d. Fx

e. Myeloma

Ans. The key is C. Paget’s disease. [Bone pain, high ALP and normal phosphate are suggestive of pagets disease. In osteoporosis Ca+, PO4³- and ALP are normal. In osteomalacia Ca+ low, PO4³- low and ALP is high. In Pagets disease Ca+ and PO4³- normal and ALP markedly raised].