title: Prevalence of Paget's disease of bone in Italy.
abstract: We examined the prevalence of PDB in Italy from radiological, scintigraphic, and biochemical surveys in two Italian towns. Prevalence rates varied from 0.7% to 2.4%, were higher in males than in females, and slightly differed between the two towns. Unlike previous studies in populations of British descent, no secular trend for a decreasing prevalence emerged.
  
  
  BACKGROUND
  Clinical, radiological, and necropsy data from different countries suggested pronounced geographical variations in the prevalence of Paget's disease of bone (PDB). Despite the impact of the disease on the population, there are limited data on the prevalence of PDB in Italy.
  
  
  METHODS
  The objective of this study was to estimate the prevalence of PDB in the district of Siena (Central Italy) and Turin (Northern Italy) from radiological, biochemical, and scintigraphic surveys. We examined a sample of 1778 consecutive pelvic radiographs performed between 1999 and 2000 at the Hospital Radiology Unit in Siena and 6609 pelvic radiographs performed in 1986-1987, 1992-1993, and 1999-2002 from the Radiology Department of Molinette Hospital in Turin. In Siena, 7906 consecutive (99m)TC-MDP bone scans performed over a 4-year period (January 2000 to May 2004) were also screened for the presence of PDB, and the prevalence of elevated alkaline phosphatase (ALP) levels (>300 UI/liter) was estimated from 7449 computerized medical records over a 3-year period (January 2000 to February 2003). The finding of PDB on the pelvic radiograph and bone scan was based on standardized radiological criteria.
  
  
  RESULTS
  At the end of the radiological surveys, 16/1778 pelvic PDB cases (8 males and 8 females) were observed in Siena and 41/6609 (27 males and 14 females) in Turin. The crude prevalence of the disease was 0.89% in Siena and 0.62% in Turin. Given that pelvic involvement is commonly described in 60-90% of PDB patients, the estimated overall prevalence of PDB ranged from 1.0% to 1.5% in Siena and from 0.7% to 1.0% in Turin. No decrease in the prevalence of PDB was evident after comparison of prevalence rates from different periods. Biochemical analyses showed 296/7449 subjects with elevated ALP levels and normal liver enzymes, 87 of whom had confirmed diagnosis of PDB. The estimated prevalence of biochemical PDB was 1.5%. The scintigraphic survey showed a PDB prevalence of 194/7906 (2.4%), which was significantly higher than the radiological and biochemical estimates.
  
  
  CONCLUSIONS
  Our surveys suggest that PDB in Italy has an estimated prevalence of at least 1%, comparable with that observed in United States and other European countries, but lower than that described in Britain and New Zealand. No secular trend for a decreasing prevalence of PDB was observed.
authors.affiliation: Department of Internal Medicine, Endocrine-Metabolic Sciences and Biochemistry, University of Siena, Siena, and Department of Radiology, U.O.A. I. S. Giovanni Battista Hospital of Torino, Italy. gennari@unisi.it
authors.forename: Luigi
authors.initials: L
authors.lastname: Gennari
authors.forename: Marco
authors.initials: M
authors.lastname: Di Stefano
authors.forename: Daniela
authors.initials: D
authors.lastname: Merlotti
authors.forename: Nicola
authors.initials: N
authors.lastname: Giordano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martini
authors.forename: Cristina
authors.initials: C
authors.lastname: Tamone
authors.forename: Roberto
authors.initials: R
authors.lastname: Zatteri
authors.forename: Roberto
authors.initials: R
authors.lastname: De Lucchi
authors.forename: Carlo
authors.initials: C
authors.lastname: Baldi
authors.forename: Angelo
authors.initials: A
authors.lastname: Vattimo
authors.forename: Silvia
authors.initials: S
authors.lastname: Capoccia
authors.forename: Luca
authors.initials: L
authors.lastname: Burroni
authors.forename: Simone
authors.initials: S
authors.lastname: Geraci
authors.forename: Vincenzo
authors.initials: V
authors.lastname: De Paola
authors.forename: Anna
authors.initials: A
authors.lastname: Calabrò
authors.forename: Annalisa
authors.initials: A
authors.lastname: Avanzati
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Isaia
authors.forename: Ranuccio
authors.initials: R
authors.lastname: Nuti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010001:Osteitis Deformans / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D010384:Pelvic Bones / Q000000981:diagnostic imaging; D015995:Prevalence; D011859:Radiography; D012189:Retrospective Studies
chemical_list: D000469:Alkaline Phosphatase