Final answer:
The next step after an X-ray suggestive of Paget's disease is to perform additional tests, particularly a bone scan and blood tests for alkaline phosphatase levels to confirm the diagnosis and differentiate it from other bone conditions.
Step-by-step explanation:
If an X-ray is suggestive of Paget's disease, which is characterized by osteolytic or mixed lytic/sclerotic lesions, the next step would typically involve further diagnostic tests. Given that Paget's disease is a bone remodeling disorder marked by an imbalance between bone resorption and bone formation, two key assessments become pertinent.
First, a bone scan may be conducted to help identify areas of active bone turnover. During this procedure, a dye containing a radioactive ion is administered, with a particular focus on areas of bone resorption. These areas will absorb the ions and consequently appear illuminated on the scan.
Second, an evaluation of blood levels of an enzyme called alkaline phosphatase is necessary. Elevated levels of this enzyme are typically indicative of active bone formation seen in Paget's disease. These diagnostic steps are integral in not only confirming the presence of Paget's disease but also distinguishing it from other conditions like osteoporosis, which does not exhibit elevated alkaline phosphatase levels.