A skull film is shown in the image

A 55-year-old white man presents to the ED complaining of diffuse, constant bone pain for the past 3 months. He is a schoolteacher, and denies any recent history of trauma or infection. He does note that his favorite fitted baseball hat no longer fits. His temperature is 37.6°C (99.7°F), blood pressure is 120/75 mm Hg, pulse is 85/min, and respiratory rate is 22/min. Physical examination reveals no focal points of tenderness. Mild frontal bossing and bilateral tibial bowing are noted. A skull film is shown in the image. What is the most likely diagnosis?


  1. Ankylosing spondylitis
  2. Paget’s disease
  3. Pituitary adenoma
  4. Rickets
  5. Scurvy1