A 68-year-old man from rural Maharashtra presents with progressive bowing of both legs over the past 3 years and recurrent bone pain. On examination, he has asymmetric limb deformity and warmth over the anterior tibiae. Serum alkaline phosphatase is markedly elevated at 420 IU/L (normal <100). Plain radiographs show characteristic 'blade of grass' appearance in the tibia with mixed lytic and sclerotic lesions. Which of the following complications is he at highest risk of developing in the next 5 years?
A 72-year-old woman presents to the orthopedic clinic with a 5-year history of progressive deformity of her right femur and left tibia. She reports bone pain that is worse at night and has been managed with NSAIDs. Serum alkaline phosphatase is 380 IU/L. Plain radiographs show characteristic 'picture frame' appearance of the vertebral body and mixed lytic–sclerotic lesions in the long bones. She is started on intravenous zoledronic acid. Which of the following is the PRIMARY mechanism by which bisphosphonates reduce bone turnover in Paget disease?
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