Observations on the natural history of Paget's disease

Whole-body skeletal scintigraphy was performed in 4700 adult patients from south-east Scotland. In 3831 with proven or suspected malignant disease the prevalence of osteitis deformans in males is 0.006 in those aged 15-54 years, 0.026 in the age group 55-84 years and 0.24 over the age of 84 years. The corresponding figures in females are 0.002, 0.021 and 0.15. Previous estimates of prevalence should be increased by at least 25% to take account of peripheral and monostotic disease, which is more common than hitherto recognised. The increase in prevalence with age may not be linear. Possible associations with environmental and genetic factors which would account for such a distribution are considered. It is suggested that the conventional distinction between 'active' and 'burned out' Paget's disease may be incorrect.