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Surgery
60 yrs old male with bony abnormality at upper tibia associated with sensorineural hearing loss. On laboratory examination serum alkaline phosphatase levels are (440 mU/1) elevated and serum Ca2+ and P042- are normal. Skeletal survey shows ivory veebrae and cotton wool spots in x-ray skull. Diagnosis is:
Fibrous dysplasia
Paget disease
Osteosclerotic metastasis
Osteoporosis
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