ECTS2013 Poster Presentations Other diseases of bone and mineral metabolism (48 abstracts)
Did Paget's bone disease changed over the last decade?
Susana Fernandes , Joana Borges , Inês Gonçalves , Luís Cunha Miranda , Rui Leitão , Alexandra Cardoso , Manuela Micaelo , Eugénia Simões , Augusto Faustino , Filipe Barcelos , Candida Silva , Miguel Sousa , Manuela Parente , Margarida Silva , Helena Madeira , Vera Las , Sara Cortes , José Melo Gomes & José Vaz Patto
Instituto Português de Reumatologia, Lisbon, Portugal.
Introduction: Paget’s bone disease (PBD) is the second most prevalent metabolic bone disease. Most patients present with pain or fracture but many remain asymptomatic. Evidence suggests a significant reduction both in its prevalence and clinical severity. Recent papers described differences in clinical course and therapeutic options in the last 10–15 years.
Objective: To characterize PBD differences between patients having been diagnosed before and after the year 2000.
Methods: Retrospective study of 75 patients from a Rheumatology Centre, evaluating demographic, clinical and therapeutic characteristics. Statistical analysis was made using Q-square, Mann–Whitney U and Spearman’s correlation.
Results: 54.7% were females, mean age of 73.4. Pain was present in 82.7%, deformity in 34.7%, hypoacusia in 17.3%, and fracture in 10.7%. Deformity was more prevalent in males (P=0.016). A familiar story was present in 6.8% of the subjects. Bone involvement included pelvis (69.3%), skull (41.3%), axial skeleton (44%), femur (22.7%), tibia (22.7%), and umerus (20%). Skull localization was more frequent in females (P=0.017) and shoulder in males (P=0.037). 71.6% had polyostotic PBD. Concomitant osteoporosis occurred in 12.2%, more frequently in females (P=0.02). Medications were alendronate (22.7%), risedronate (12%), pamidronate (48%), and zolendronate (69%). The subset of patients diagnosed after the year 2000 (n=46) had less fractures (P=0.002) and less umeral involvement (P=0.031). Alendronate (P=0.012) and Pamidronate (P<0.0001) were more frequently prescribed before the year 2000. No differences were found for Risedronate or Zolendronate. Total serum alkaline phosphatase (ALP) and the difference between the highest and current levels were higher in subjects diagnosed before the year 2000 (P=0.004; ALP max 887 vs 389).
Discussion: Our data suggests that in the last decade patients with PBD attain lower levels of ALP and report less fractures. That may be related to a generalized use of bisphosphonates in a context of earlier diagnosis.
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