A 70-year-old female presents to the outpatient clinic reporting a progressive aching pain in her right thigh and left hip over the past several months, which is worse with weight-bearing. She also mentions a recent increase in her hat size, noting her old hats feel uncomfortably tight, and a noticeable decline in her hearing, especially for high-pitched sounds. On physical examination, her vital signs are stable. Musculoskeletal examination reveals a mild bowing deformity of the right femur and tenderness to palpation over the left anterior iliac crest. She has full range of motion in her hips and knees, though crepitus is noted in both patellofemoral joints. Neurological examination is unremarkable. A recent skeletal scintigraphy showed increased radiotracer uptake in the calvarium, right proximal femur, and left ilium. Considering the most likely diagnosis, what initial laboratory finding would confirm this condition, and what is the primary pharmacological treatment strategy?

A 72-year-old female presents to a general internal medicine clinic reporting a progressive aching pain in her left hip and right tibia over the past six months, which worsens with weight-bearing. She also mentions that her head circumference seems to be increasing, as her hats no longer fit, and her husband has noticed a significant decline in her hearing. She denies any history of trauma, fever, or weight loss. On physical examination, there is localized warmth and tenderness over the anterior aspect of the right tibia and the left iliac crest. Cranial nerve examination reveals sensorineural hearing loss bilaterally. Neurological examination is otherwise unremarkable. Blood tests reveal an elevated alkaline phosphatase level. Imaging studies, including a bone scan, were subsequently performed. Considering this patient's presentation and initial findings, what is the most likely diagnosis and the appropriate first-line pharmacologic intervention to manage her condition and prevent further complications?

A 68-year-old retired architect, with a past medical history of essential hypertension and mild osteoarthritis, presents to a community medical clinic complaining of persistent, deep aching pain in his lower back and left tibia that has progressively worsened over the past three months. He describes the pain as dull and constant, unremitting with over-the-counter analgesics. He also reports a gradual, insidious decrease in his hearing, especially in his right ear, which he initially attributed to age-related changes. He denies any recent trauma, fever, or unintentional weight loss. His family history is notable for a sibling who developed a "bone disease" with similar symptoms later in life. On physical examination, his vital signs are stable: temperature 37.1°C, blood pressure 145/88 mmHg, pulse 65/min, respirations 14/min, and oxygen saturation 98% on room air. Musculoskeletal examination reveals diffuse tenderness upon palpation over the lumbar spine and the anterior aspect of the left tibia. There is no warmth, erythema, or swelling noted on the affected areas. Neurological exam reveals mild bilateral sensorineural hearing loss, more pronounced on the right side. Abdominal and dermatological exams are unremarkable. Laboratory values are provided below. Based on the clinical presentation and initial laboratory findings, what is the most likely diagnosis and the recommended initial pharmacologic management?

A 68-year-old woman presents to her primary care provider's clinic for a routine follow-up, though she mentions a persistent, dull ache in her right hip that has been present for approximately 9 months. She denies any recent trauma but reports the pain occasionally worsens with prolonged standing. Her vital signs are stable. Physical examination reveals a slight bowing of the right femur and localized warmth over the greater trochanter, with mild tenderness to palpation. Hip range of motion is mildly restricted with crepitus, but neurovascular status distally is intact. Imaging previously obtained showed a thickened, sclerotic cortex and coarsened trabecular pattern in the right proximal femur. Given her chronic symptoms and findings, what is the most appropriate initial long-term management strategy for this patient, and what is a significant potential oncological complication requiring diligent monitoring?

A 68-year-old woman presents to her general practitioner's office complaining of progressive right hip discomfort, described as a deep ache, along with a noticeable decline in her hearing over the past year. She also mentions occasional headaches and a feeling of general fatigue. Her medical history includes well-controlled hypertension and a prior appendectomy. She previously worked as a librarian and is now enjoying retirement. On examination, her vital signs are: temperature 37.2°C, blood pressure 150/85 mmHg, pulse 78/min, respirations 16/min, and oxygen saturation 99% on room air. Physical examination reveals mild tenderness over the right greater trochanter and bilateral symmetric sensorineural hearing loss on audiometry. A recent cranial imaging performed due to persistent headaches revealed distinct findings. Laboratory investigations were subsequently ordered. Given these findings, what is the most likely diagnosis and the appropriate initial pharmacologic management?

A 68-year-old woman presents to her primary care physician's office complaining of gradually worsening right lower leg pain over the past year, which is dull, aching, and persistent, not relieved by rest. She also mentions that her hats no longer fit, and she's noticed a subtle bowing of her right tibia. She reports no recent trauma or significant weight loss. Her past medical history is unremarkable. On examination, her temperature is 37.1°C, blood pressure is 135/85 mmHg, pulse is 72/min, and respirations are 16/min. Palpation of the right tibia reveals warmth and mild tenderness. Her gait appears normal, and neurological examination of the lower extremities is intact. Distal pulses are palpable. Given these findings, what is the most likely diagnosis and the initial management strategy, including consideration for long-term complications?

A 72-year-old woman with a documented history of Paget's disease affecting her skull and pelvis presents to the general medical clinic with a 6-month history of progressive bilateral hearing loss and occasional pulsatile headaches, which are worse at night. Her last disease activity markers were noted to be elevated a year ago, but she did not pursue treatment at that time. She denies dizziness, tinnitus, or focal neurological deficits other than the hearing changes. On physical examination, her general appearance is stable, and vital signs are within normal limits. Otoscopic findings are normal, revealing clear external auditory canals and intact tympanic membranes. Audiometry performed in the clinic shows bilateral moderate sensorineural hearing loss, more pronounced in the high frequencies. Cranial nerve examination is otherwise unremarkable. There are no palpable masses or deformities of the skull noted, and she has full range of neck motion without pain. What is the most likely diagnosis for her new symptoms and the optimal initial management strategy?