Jigsaw Puzzle - A Classical Dossier of Paget’s Disease

Paget’s disease (PD) is a chronic bone disease characterised by increased resorption followed by excessive bone formation resulting in bone pain and fractures. PD is most common in the elderly and many are initially asymptomatic but can develop severe complications as disease progresses. Serum alkaline phosphatase is an important biochemical marker which is elevated in these patients. A clinical lion like face and radiological “cotton wool appearance” and a “jigsaw puzzle” pattern on histopathological examination are the characteristic features of PD. Bisphosphonates are the most commonly used drug of choice for treatment of patients with Paget’s disease. We discuss a classic case of PD involving a 70 year old female in this case report.