[Skeletal distribution and biological markers of Paget's disease]

The authors have re-examined the skeletal distribution of Paget's disease of bone by means of radionuclide bone scanning performed in 170 untreated pagetic subjects (93 men, 77 women). 863 high uptake foci were detected. The finding that 8.3 p. 100 of the sites revealed by scanning were not visible on X-ray films shows that the disease is underdetected by standard radiography. Peripheral foci in the feet and hands were discovered in more than a quarter of the patients. There was a significant positive correlation between skeletal extension index on the one hand and plasma alkaline phosphatase and hydroxyprolinuria levels on the other hand, these markers being normal in about 7 p. 100 of the cases. Over two-thirds of the foci detected (69 p. 100) were asymptomatic. The skeletal extension index did not increase with age. Serum calcitonin is not a sensitive marker of the increased bone formation characteristic of Paget's disease, and it has little practical value to evaluate the effects of treatments.