European distribution of Paget's disease of bone

The prevalence of Paget's disease of bone was mapped from 1416 replies to a postal questionnaire sent to radiologists throughout Western Europe. Subsequently radiological surveys were carried out in 13 towns in nine countries. The two surveys showed a remarkable geographical distribution. The prevalence of the disease was higher in Britain than in any other Western European country. Only in France did the prevalences reach the lowest values among those previously recorded in a survey of 31 British towns. The lowest rates in any country were in Sweden and Norway. These findings have implications for the hypothesis that the disease is caused by a virus infection and suggest the existence of one or more as yet unknown cofactors.