Doctors discovered an unusual case where one 71-year-old man had three different bone problems at the same time: Paget’s disease (abnormal bone growth), a parathyroid tumor causing hormone imbalance, and weak bones with fractures. This combination is extremely rare and had never been clearly documented together before. The patient experienced loss of appetite, difficulty swallowing, and weakness, which doctors believe came from his mineral imbalances rather than bone pain. He was treated with a strong bone medication called zoledronate and will need careful monitoring. This case teaches doctors to look for multiple bone problems together and to carefully distinguish between different types of parathyroid conditions.

The Quick Take

  • What they studied: A single patient who had three rare bone conditions occurring at the same time: abnormal bone growth (Paget’s disease), a tumor affecting parathyroid hormones, and osteoporosis with spine fractures.
  • Who participated: One 71-year-old man without a smoking history who had heart problems and was taking vitamin D supplements. He came to the hospital complaining of difficulty swallowing, tiredness, loss of appetite, and weight loss over two months.
  • Key finding: This patient had an exceptionally rare combination of three bone diseases occurring together. His parathyroid hormone levels were high (163 pg/mL) despite normal calcium levels, caused by a small tumor on his parathyroid gland. He also had Paget’s disease in his left arm bone and multiple broken vertebrae in his spine.
  • What it means for you: This case is primarily important for doctors to recognize that multiple bone diseases can occur together and may cause general symptoms like weakness and appetite loss rather than obvious bone pain. If you have unusual symptoms and bone concerns, doctors should investigate thoroughly for multiple conditions.

The Research Details

This is a case report, which means doctors documented the medical story of one specific patient in detail. The 71-year-old man came to the hospital with general symptoms like difficulty swallowing, tiredness, and weight loss. Doctors performed blood tests, CT scans (detailed X-ray pictures), and bone imaging to figure out what was wrong. They found three separate bone problems: a parathyroid tumor, Paget’s disease in one arm bone, and weak bones with spine fractures. The doctors then treated him with a strong bone medication and planned to follow up with him over time.

The case report approach is valuable because it documents a rare medical situation in detail, helping other doctors recognize similar patterns. However, because it’s just one patient, we cannot make broad conclusions about how common this combination is or how well the treatment works for everyone.

Case reports are important for identifying rare disease combinations and teaching doctors to think about multiple conditions at once. In this situation, the patient’s symptoms (weakness, appetite loss, difficulty swallowing) could have been mistaken for just one condition, but careful testing revealed three separate bone problems. This teaches doctors to be thorough when patients have confusing symptoms.

This is a detailed medical case report from a peer-reviewed journal, meaning other doctors reviewed it before publication. The doctors used multiple testing methods (blood tests, CT scans, bone imaging) to confirm their findings, which strengthens the reliability. However, because it’s only one patient, the findings cannot be generalized to larger populations. The rarity of this combination means it may never be seen again, so we cannot predict how common it truly is.

What the Results Show

The patient had three bone conditions occurring simultaneously. First, blood tests showed elevated parathyroid hormone (PTH) at 163 pg/mL, which is high, but his calcium level was normal at 9.3 mg/dL. This unusual combination is called normocalcemic primary hyperparathyroidism. CT imaging revealed a small tumor (1.2 cm) on his right parathyroid gland, which was causing the hormone imbalance.

Second, imaging also showed Paget’s disease in his left arm bone. This is a condition where bone grows abnormally and becomes weak and deformed. Bone scans confirmed this diagnosis. Third, the patient had osteoporosis (very weak bones) with multiple fractures in his spine, which are serious because they can cause disability.

Blood markers showed increased bone turnover, meaning his bones were breaking down and rebuilding at abnormal rates. Interestingly, his alkaline phosphatase enzyme was normal, which is unusual because Paget’s disease typically raises this enzyme. The patient also had small kidney stones, which can be associated with parathyroid problems.

The patient’s main symptoms were loss of appetite, difficulty swallowing, tiredness, and weight loss over two months. Notably, he did not experience bone pain despite having three serious bone conditions. Doctors believe his symptoms came from the mineral metabolism disturbances (imbalances in calcium and phosphorus regulation) rather than from the bone diseases themselves. The presence of kidney stones suggests his parathyroid condition was affecting his kidneys’ ability to handle minerals properly.

According to the doctors, the combination of normocalcemic primary hyperparathyroidism with Paget’s disease and osteoporosis has rarely, if ever, been documented together before. While each condition individually is known to doctors, finding all three in one patient is exceptional. The case of Paget’s disease with normal alkaline phosphatase has been reported in rare cases previously, but the full combination described here appears to be unique in medical literature.

This is a single case report, so the findings apply only to this one patient and cannot be generalized to larger groups. We cannot determine how common this combination truly is or whether the treatment approach will work the same way for other patients. The patient’s specific medical history (cardiovascular disease, vitamin D supplementation) may have contributed to his conditions in ways that might not apply to others. Long-term follow-up results are not yet available, so we don’t know the ultimate outcome of his treatment. Additionally, the rarity of this combination means it may never be seen again, limiting opportunities to study it further.

The Bottom Line

For this specific patient: Treatment with zoledronate (a strong bone-strengthening medication) was chosen to address all three bone conditions simultaneously. The dose was adjusted based on kidney function. Long-term follow-up monitoring is essential. For general readers: If you have unexplained symptoms like persistent weakness, appetite loss, or difficulty swallowing combined with bone concerns, ask your doctor to thoroughly investigate for multiple conditions rather than assuming one diagnosis. This case shows the importance of comprehensive testing.

This case is most relevant to doctors and healthcare providers who treat bone diseases, parathyroid conditions, and osteoporosis. Patients with any of these individual conditions should be aware that multiple bone problems can occur together. People with a family history of parathyroid disease or Paget’s disease should discuss screening with their doctors. Anyone experiencing unexplained general symptoms combined with bone concerns should seek thorough medical evaluation.

In this case, the patient’s symptoms developed over two months before hospitalization. Treatment with zoledronate was started, but long-term results are not yet reported. Typically, bone-strengthening medications take several months to show effects on bone density and fracture risk. The patient will require ongoing monitoring with blood tests and imaging over months to years to assess treatment effectiveness and watch for complications.

Want to Apply This Research?

  • If you have bone health concerns, track monthly: (1) any bone or joint pain or discomfort, (2) general symptoms like fatigue or appetite changes, (3) any falls or injuries, and (4) medication adherence. Note the date and severity of each symptom to share with your doctor.
  • Work with your healthcare provider to: (1) ensure adequate calcium and vitamin D intake through diet or supplements, (2) perform weight-bearing exercises like walking as tolerated, (3) maintain regular follow-up appointments for blood tests and imaging, and (4) report new symptoms promptly rather than waiting for them to worsen.
  • Set up quarterly check-ins with your healthcare team to review blood test results (calcium, phosphorus, PTH levels, and bone markers), imaging results, and symptom changes. Use the app to log any new symptoms between appointments and track medication compliance. This long-term approach helps catch complications early and adjust treatment as needed.

This case report describes one patient’s medical situation and should not be used for self-diagnosis or self-treatment. The combination of conditions described here is extremely rare and may not apply to your situation. If you have concerns about bone health, parathyroid function, or unexplained symptoms like weakness or appetite loss, consult with a qualified healthcare provider for proper evaluation and personalized treatment. This information is educational and does not replace professional medical advice. Always discuss any new symptoms or treatment concerns with your doctor before making changes to your care plan.