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Key Clinical Message Paget's disease of bone (PDB) is a chronic condition causing abnormal bone remodeling, leading to pain, fractures, and complications. A 57‐year‐old female patient, asymptomatic and devoid of pain, incidentally exhibited elevated levels of alkaline phosphatase. Following a thorough consideration of potential differential diagnoses, the eventual diagnosis established was PDB. We recommended Fosamax (70 mg alendronate tablets) at two tablets twice weekly for 3 months to manage PDB due to patient preference and side effects with intravenous zoledronic acid. Subsequent assessments of alkaline phosphatase levels during follow‐up examinations post‐treatment revealed a reduction in their values.