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Surgery
An 80-year-old man presents with slowly progressive enlargement of his head circumference, deformities of long bones and spine, and chronic pain of the affected skeletal segments. Laboratory studies show elevated serum alkaline phosphatase and high urine hydroxyproline. X-ray findings are consistent with Paget disease. Which of the following is the most likely pathogenetic mechanism of this condition?
Generalized reduction in bone mass
Genetic deficiency of carbonic anhydrase II
Monoclonal proliferation of plasma cells
Paramyxovirus infection of osteoclasts
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