Background Studies conducted in different areas have shown a decrease in both the prevalence and severity of Paget’s disease of bone (PDB) in the last few years . It has also been observed that the disease is more frequent in older people than it has in the past.
Objectives To describe the extension and disease activity of PDB over time.
Methods A registry-based cross-sectional study was performed. It started with a prevalence study (2006-2007) in which stratified samples of abdominal radiographs throughout Spain, of subjects aged ≥55 years from stored consecutive digitalized films in selected hospitals were obtained. Radiographs including all lumbar vertebrae, pelvis, sacrum and femoral heads, were examined for the diagnosis of PDB, according to standardized criteria. Afterwards, experts on PDB were invited to include patients in the Registry from their clinics (apart from those identified in the prevalence study). Data were recorded following a standardized electronic form. From this registry we selected patients with a bone scan and alkaline phosphatase (AP) measurement in the year of diagnosis. Those on bisphosphonates during the last five years before the bone scan were excluded. Data related to the disease extension, expressed as the percentage of the affected skeleton and calculated by the Coutris’ index, and the activity of the disease measured by Renier’s index using AP activity, were obtained. The evaluation of the bone scan was performed by 2 experts, and the AP value converted into international units when necessary. A descriptive analysis was performed and the study sample was divided into2 groups: patients diagnosedbefore 1995 and those after 1995.
Results A total of 214 patients were analyzed. 54 patients (26%) were diagnosed with PDB before 1995, 149 (74%) after 1995 and in 11, this date was unknown. The median Renier’s index was 40 (p25-p75: 16-72) vs. 39 (p25-p75: 19-74), without significant differences between groups. However, there were significant differences in the mean age at the diagnosis of PDB, 59 (SD=8) vs. 65 (SD=11) and in mean Coutris’ Index, 8 (SD=5) vs. 6 (SD=5). We found a non-significant decrease in the percentage of women diagnosed with PDB in both groups, from 52% to 42%. There were no differences between groups in the percentage of familiar history (7% vs. 8%) and other environmental factors such as contact with animals, measles, or the consumption of non pasteurized milk. Figure 1 shows the evolution of Coutris and Reiner indexes over time.
Conclusions The results show that, in the last 15 years, Paget’s disease has been diagnosed at a more advanced age andthe skeletal extension is lower, without changes in t the disease activity. Changes over time in the characteristics of PDB in Spain do not seem to be related to the explored environmental factors.
Cooper C, Schafheutle K, Dennison E, et al. The epidemiology of Paget’s disease in Britain: is the prevalence decreasing? J Bone Miner Res 1999; 14(2):192-197.
Morales-Piga AA, Bachiller-Corral FJ, Abraira V, et al. Is clinical expressiveness of Paget’s disease of bone decreasing? Bone 2002; 30(2):399-403.
Disclosure of Interest None Declared