Evidence for secular change in Paget's disease

Area of Science:

• Bone Diseases
• Rheumatology
• Geriatrics

Background:

• Historical death certification data suggests a decline in severe Paget's disease of bone since the late 19th century.
• This indicates a potential secular trend towards less severe forms of the condition.

Purpose of the Study:

• To analyze trends in disease severity and patient demographics over a 21-year period at a specialized Paget's disease clinic.
• To investigate changes in the presentation of Paget's disease of bone over two decades.

Main Methods:

• Retrospective review of 1041 patients attending a Paget's disease clinic from 1973 to 1993.
• Analysis of initial plasma alkaline phosphatase levels, patient age, and extent of skeletal involvement (scintigraphy) to assess disease severity.
• Comparison of patient data between early (1973-1978) and late (1988-1993) periods.

Main Results:

• Despite increased referrals, there was a significant decrease in the number of new patients presenting with severe Paget's disease (plasma alkaline phosphatase > 500 U/L and > 1000 U/L).
• The average age of newly referred patients increased significantly from 62 to 71 years.
• Skeletal involvement decreased in patients born after 1926 compared to those born before 1915.

Conclusions:

• Newly referred patients with Paget's disease of bone are presenting with less severe disease and at an older age than two decades prior.
• This suggests a continued secular trend towards milder forms of Paget's disease, impacting diagnosis and management strategies.