AFTER THE FALL, THE AUTUMN OF LIFE BEGINS!

Introdution: Paget disease of bone is a focal disorder of bone metabolism that occurs in the aging skeleton. Method Female, 79 years old, autonomous, with a history of hypertension. In August 2014 she fell over her left shoulder with anterior glenoid fracture. In April 2015 she underwent an MRI on her shoulder, prescribed by Physical Medicine and Rehabilitation (PMR) in the hospital. The patient lost her next PMR’s appointment. That year, her family doctor advised her to reschedule the lost hospital appointment and bring the results of the exams performed there. In January 2016, on another family doctor’s appointment she brought the MRI result that reported "lytic images in the shoulder blade suggesting Paget's disease”. Then it was prescribed the phospho-calcium metabolism study and the serum alkaline phosphatase level and the patient was questioned about the presence of bone pain. Currently she awaits these results to provide the appropriate treatment. Results and Conclusions The onset of Paget disease of bone is often after middle age. It is characterized by accelerated bone turnover and abnormal bone remodelling. It is frequently asymptomatic, but the common clinical manifestations include bone pain or chronic back pain. Laboratory findings include elevated levels of serum alkaline phosphatase. Plain radiographs reflect, early in disease, a predominantly osteolytic lesion but in late disease, there may be dense bone present. Diagnosis in patients with clinical or laboratory findings suggestive of disease is confirmed by the demonstration of characteristic radiographic changes and most patients should initiate treatment with bisphosphonates.