How do I install the Endo Paget Bisphosphonate Paraplegia Spine skill?

Run npx skillmds@latest add dromlakhani/endo-paget-bisphosphonate-paraplegia-spine in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

Is Endo Paget Bisphosphonate Paraplegia Spine safe to use?

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Which AI agents work with Endo Paget Bisphosphonate Paraplegia Spine?

This skill is tagged as working with Claude Code, Claude.ai, OpenAI Codex. SKILL.md is an open format, so most agents that read a skills directory can load it too.

Is Endo Paget Bisphosphonate Paraplegia Spine free to use?

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Who published Endo Paget Bisphosphonate Paraplegia Spine?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Endo Paget Bisphosphonate Paraplegia Spine by dromlakhani

Name: Endo Paget Bisphosphonate Paraplegia Spine
Rating: 4.2 (5 reviews)
Author: dromlakhani

Endo Paget Bisphosphonate Paraplegia Spine

This skill recommends immediate administration of a potent intravenous bisphosphonate with neurosurgical consultation for patients presenting with paraplegia or progressive spinal stenosis attributable to spinal Paget's disease. Clinical triggers include new-onset paraplegia, worsening lower‑extremity weakness, or spinal stenosis symptoms in a patient with established spinal Paget's disease.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Immediate bisphosphonate for spinal Paget's-associated paraplegia

STEP 1 — Gather Information

Confirm diagnosis of spinal Paget's disease (prior imaging or biopsy), document onset and progression of paraplegia or spinal stenosis symptoms, perform neurologic exam, obtain MRI spine to assess cord compression and structural integrity, check serum alkaline phosphatase (ALP) and renal function, and arrange neurosurgical consultation.

STEP 2 — Rule In / Rule Out

Is there known spinal Paget's disease with new or worsening paraplegia/spinal stenosis symptoms?

Yes → proceed to Step 3.
No → consider alternative causes (e.g., acute disc herniation, tumor, vascular) and investigate accordingly.

STEP 3 — Classify or Stratify

Assess MRI for severe structural damage (e.g., vertebral collapse, kyphosis >30°, canal compromise requiring decompression).

Severe structural damage → proceed to Step 4 with surgical planning.
No severe structural damage → proceed to Step 4 for medical management.

STEP 4 — Decide

If no severe structural damage: administer a single 5 mg IV dose of zoledronate (or equivalent potent IV bisphosphonate) and continue neurosurgical consultation for monitoring.
If severe structural damage: proceed to neurosurgical evaluation for possible decompression while initiating the same IV bisphosphonate peri‑operatively.

Clinical Guardrails / Mimics / Pitfalls

Do not delay bisphosphonate awaiting surgery unless there is acute instability; avoid relying on oral bisphosphonates for acute neurologic deterioration; monitor for acute phase reaction, hypocalcemia, and renal toxicity after IV zoledronate; do not assume paraplegia is irreversible; ensure vitamin D repletion and calcium supplementation; avoid high‑dose steroids which can worsen bone turnover.

Concrete Clinical Example

A 68‑year‑old man with known lumbar Paget's disease presents with sudden leg weakness and urinary urgency; MRI shows cord thickening at L1 without vertebral collapse; ALP is elevated; neurosurgery is consulted; he receives zoledronate 5 mg IV; his strength improves over 3‑4 weeks.

Source: Paget’s Disease of Bone: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2014, DOI: 10.1210/jc.2014-2910

---name: endo-paget-bisphosphonate-paraplegia-spinedescription: This skill recommends immediate administration of a potent intravenous bisphosphonate with neurosurgical consultation for patients presenting with paraplegia or progressive spinal stenosis attributable to spinal Paget's disease. Clinical triggers include new-onset paraplegia, worsening lower‑extremity weakness, or spinal stenosis symptoms in a patient with established spinal Paget's disease.---# Immediate bisphosphonate for spinal Paget's-associated paraplegia## STEP 1 — Gather InformationConfirm diagnosis of spinal Paget's disease (prior imaging or biopsy), document onset and progression of paraplegia or spinal stenosis symptoms, perform neurologic exam, obtain MRI spine to assess cord compression and structural integrity, check serum alkaline phosphatase (ALP) and renal function, and arrange neurosurgical consultation.## STEP 2 — Rule In / Rule OutIs there known spinal Paget's disease with new or worsening paraplegia/spinal stenosis symptoms? - **Yes** → proceed to Step 3. - **No** → consider alternative causes (e.g., acute disc herniation, tumor, vascular) and investigate accordingly.## STEP 3 — Classify or StratifyAssess MRI for severe structural damage (e.g., vertebral collapse, kyphosis >30°, canal compromise requiring decompression). - **Severe structural damage** → proceed to Step 4 with surgical planning. - **No severe structural damage** → proceed to Step 4 for medical management.## STEP 4 — DecideIf no severe structural damage: administer a single 5 mg IV dose of zoledronate (or equivalent potent IV bisphosphonate) and continue neurosurgical consultation for monitoring. If severe structural damage: proceed to neurosurgical evaluation for possible decompression while initiating the same IV bisphosphonate peri‑operatively.## Clinical Guardrails / Mimics / PitfallsDo not delay bisphosphonate awaiting surgery unless there is acute instability; avoid relying on oral bisphosphonates for acute neurologic deterioration; monitor for acute phase reaction, hypocalcemia, and renal toxicity after IV zoledronate; do not assume paraplegia is irreversible; ensure vitamin D repletion and calcium supplementation; avoid high‑dose steroids which can worsen bone turnover.## Concrete Clinical ExampleA 68‑year‑old man with known lumbar Paget's disease presents with sudden leg weakness and urinary urgency; MRI shows cord thickening at L1 without vertebral collapse; ALP is elevated; neurosurgery is consulted; he receives zoledronate 5 mg IV; his strength improves over 3‑4 weeks.**Source:** Paget’s Disease of Bone: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2014, DOI: 10.1210/jc.2014-2910

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