A 58-year-old man comes to the physician because of headaches and back pain for 5 months. He also noted that his favorite hat no longer fits him. He has hypertension, hypothyroidism, and benign prostate hyperplasia. His father had prostate cancer and osteoporosis. Current medications include calcium supplementation, metoprolol, and L-thyroxine. He does not smoke or drink alcohol. Vital signs are within normal limits. On examination, there is enlargement of the anterior head. An x-ray of the skull shows a thickened calvaria and osteoblastic and osteolytic lesions. The initial phase of this patient's disorder involves increased activity of which of the following cell types?

Question

A 58-year-old man comes to the physician because of headaches and back pain for 5 months. He also noted that his favorite hat no longer fits him. He has hypertension, hypothyroidism, and benign prostate hyperplasia. His father had prostate cancer and osteoporosis. Current medications include calcium supplementation, metoprolol, and L-thyroxine. He does not smoke or drink alcohol. Vital signs are within normal limits. On examination, there is enlargement of the anterior head. An x-ray of the skull shows a thickened calvaria and osteoblastic and osteolytic lesions.   The initial phase of this patient's disorder involves increased activity of which of the following cell types?

Quizplus · Accepted Answer

Eductional Objective: Bone pain and elevated alkaline phosphatase level in an elderly patient can occur with osteoblast metastases and Paget disease of bone (PDB).  Biopsy showing a mosaic pattern of lamellar bone is diagnostic for PDB.  The initial phase in PDB is characterized by an increase in osteoclastic activity.

A 58-Year-Old Man Comes to the Physician Because of Headaches