A rare case of Paget's disease of the bone in the Philippines.

A 40-year-old Filipina presented with a 2-year history of progressive bilateral inguinal and hip pain with limited range of motion. She had a bad fall which led to widespread body pains for 6 months partially relieved on multiple analgesic and anti-inflammatory agents. There was progressive weight loss and anemia. Focused musculoskeletal examination revealed moderate degree of generalized muscle atrophy, pain-limited range of motion of bilateral hip and shoulder joints, with equivocal muscle strength of both proximal and distal muscle groups of all extremities. Metastatic bone disease was ruled out when skeletal survey disclosed mixture of osteolytic and osteoblastic lesions, predominantly osteoblastic, on multiple sites. Bone turnover markers were elevated. Bone biopsy revealed histopathologic results compatible with Paget's disease of the bone. Management included oral calcium and vitamin D supplement followed by parenteral zoledronic acid, and a rehabilitation program. Four months after bisphosphonate therapy, the patient reported significant relief of symptoms with complete resolution of the previously noted generalized body pains, although she ambulates with use of an assistive device. Due to the rarity of the condition among Filipinos, this case was a diagnostic dilemma in itself, as it is most likely the first published case in the Philippine literature.