Paget's disease in a 5-year-old: acute response to human calcitonin

A five-year-old boy presented with a three-and-a-half-year history of repeated bone fractures and progressive bone deformity. The excretion of hydroxyproline in the urine was greatly increased, and serum alkaline phosphatase and acid phosphatase levels were very high. These abnormalities together with the findings on bone histology and radiology suggested a diagnosis of juvenile Paget's disease. Human calcitonin reduced the bone turnover as evidenced by an immediate and sustained fall in urine hydroxyproline excretion, while calcium and phosphate balance became more positive. This treatment is therefore being continued on an outpatient basis.