Background It is widely recognised that the United Kingdom has a very high prevalence of Paget's disease of the bone (PDB) alongside Western Europe, Australia and New Zealand.
In 1980, Barker et al (1), concluded from a meta-analysis of surveys done throughout 31 towns in Britain, that Lancashire showed to be a remarkably localised area of high prevalence of PDB. In 2006, Cooper et al (2) updated the prevalence of PDB in certain British centres and found prevalence rates had fallen by 50%.
Objectives As there have been no further studies around the Lancashire area since, we aim to build on the current literature and present the prevalence of PDB in some local towns within Lancashire, 20 years later.
Methods We began with Southport and Ormskirk the NHS trust whose patients are geographically located within the county of Lancashire. A computer generated random sample was listed for all plain x-rays that include entire lumbar vertebrae, pelvis, sacrum and femoral heads in those aged over 55. We identified 1000 patients whose unique hospital numbers were entered into the PACS system to view each x-ray.
Results Out of 1000 patient x-rays only four were found to have definite evidence of PDB, all confirmed with radiological report. This gives a prevalence rate of 0.4%. Of these, 50% were female and the age ranged from 72–88 years.
Conclusions Southport and Ormskirk towns lie just on the verge of the Lancashire focus (Lancaster, Preston, Bolton, Wigan, Burnley and Blackburn) therefore using the methodology, it was assumed that prevalence rates would be as high (4–8%) as other Lancashire's towns. (1). Consideration to the high socioeconomic status of many –albeit an older population- that live in the studied area and perhaps other environmental factors might explain the low prevalence (0.4%) of PDB. The influence of genetic factors seems less evident.
Additionally, the overall downward trend of prevalence rates in the UK, as hypothesised by Cooper et al (2), could also explain our findings.
This is an area that would be useful to investigate in further studies. An initial plan to re-study a high focus area such as Lancaster town, using the same methodology, might be extremely valuable.
Barker DJP, Chamberlain AT, Guyer PB, Gardener MJ. Paget's disease of bone: The Lancashire focus. BMJ. 1980; 280(6222):1105–7
Cooper C, Harvey NC, Dennison EM, van Staa TP. Update on the epidemiology of Paget's disease of bone. J Bone Miner Res. 2006; 21: 3–8
Disclosure of Interest None declared