<s>[INST] context: (Extent and severity of the disease) (2281-H)PAGET'S DISEASE (osteitis deformans) - characterized by enlargement and thickening of the bone, but the internal architecture is abnormal and the bone is unusually brittle.* * Pelvis and tibia being the commonest site, and the femur, skull, spine and clavicle the next commonestComplication:* Nerve compression (impaired vision facial palsy trigeminal neuraligia or deafness) spinal stenosis** Factures - femoral neck.* * Osteoarthritis - atrophic arthritis with sparse remodelling* * Bone sarcoma - malignant change in probably around 1%* * High output cardiac failure - due to prolonged, increased bone blood flow* * Hyper calcemiaBiochemical investigation - Disease activity is gauged by the increased in serum alkaline phosphate and urinary hydroxy proline levels.* The degree of bone markers (ALP & hydroxyproline) elevation reflects the extent and severity of the disease (228-H)* Total serum ALP remains the test of choice both for diagnosis and assessing response to therapy* Lower values suggests less extensive involvement or a quiescent phase of the disease [/INST] question: 24 hours estimation of urinary hydroxyproline levels is a good indicator to | options: A: Poor outcome of paget's disease B: Diagnosis of the pagets disease C: Recurrence of the pagets disease D: Extent and severity of the disease | answer: D </s>