A 50-year-old patient has lower extremity pain and increased warmth, with sclerotic areas on X-ray. What is the most probable diagnosis?

• A. Osteoarthritis
• B. Multiple myeloma
• C. Paget's disease
• D. Osteoporosis

Answer: (C)

The most probable diagnosis in this case is Paget's disease. This condition is characterized by abnormal and excessive bone remodeling, which can lead to areas of increased bone density, often presenting as sclerotic regions on X-ray. The patient's symptoms—lower extremity pain and increased warmth—align with the common manifestations of Paget's disease, where affected bones can become enlarged, deformed, and vascularized, leading to warmth in the area due to increased blood flow.

Paget's disease typically occurs in older adults and can be confirmed through imaging studies that reveal sclerotic and enlarged bones. The pattern of bone involvement and the associated symptoms of pain and warmth are significant indicators for this diagnosis.

Other conditions present different sets of symptoms and findings. For example, osteoarthritis usually involves joint pain and stiffness rather than significant warmth and does not present with sclerotic areas on an X-ray. Multiple myeloma, on the other hand, often leads to osteolytic lesions rather than sclerotic areas, and it may present with systemic symptoms like weight loss or fatigue rather than localized warmth. Osteoporosis, while it does involve a decrease in bone density and can lead to fractures, does not typically present with localized warmth or sclerotic areas on