Paget disease of bone is a common disease characterized by focal areas of increased bone turnover disorder that may involve a single bone (monostotic) or multiple bones (polyostotic). Signs described of enlargement of the vertebral body, preservation of the bone marrow and thickened cortex of vertebral body (picture frame vertebral body) suggest the diagnosis. Although many patients are asymptomatic, significant symptoms including bone pain may be present, as in this case.