title: Evidence for increased clinical severity of familial and sporadic Paget's disease of bone in Campania, southern Italy.
abstract: The analysis of 236 Italian patients with Paget's bone disease showed higher clinical severity and greater frequency of neoplastic degeneration among patients who live or descend from individuals living in the Campania region (southern Italy). A prevalent involvement of the spine and the skull, the sites preferentially involved in giant cell tumors complicating Paget's disease, was also shown in familial cases from this geographical region.
  
  
  BACKGROUND
  The Campania region in southern Italy has been recently indicated as a high prevalence area for Paget's disease of bone (PDB), and most pagetic families with multiple occurrence of neoplasms in affected members were from this geographical region.
  
  
  METHODS
  We evaluated the PDB epidemiological characteristics in 125 patients from Campania in comparison with 111 patients from other Italian regions. Twenty-three patients from Campania and 26 patients from other Italian areas had at least one first-degree relative affected by PDB (familial cases). The remaining patients made up the sporadic cases.
  
  
  RESULTS
  Among subjects from Campania, the patients in the familial group tended to come from larger families and showed at diagnosis higher serum total alkaline phosphatase, larger extension of disease, and earlier mean age with respect to patients with PDB of the sporadic group. The skull, spine, and humerus were the sites preferentially involved in the familial cases. In contrast, no such differences were observed between familial and sporadic PDB cases among patients from the other geographical areas, except for a lower age at diagnosis. An increased PDB clinical severity was finally observed in the PDB cohort from Campania in comparison with patients from other Italian regions. Neoplastic degeneration of pagetic bones (osteosarcoma and giant cell tumor) was exclusively observed in patients with polyostotic PDB from Campania.
  
  
  CONCLUSIONS
  We showed a higher clinical severity of PDB with occurrence of neoplastic degeneration in the high prevalence area of Campania, with its maximum expression in cases with familial disease. This peculiar pattern might be traced to genetic predisposition and/or to the abnormal impact of a still undefined environmental trigger.
authors.affiliation: Department of Clinical and Experimental Medicine, Federico II University Medical School, Naples, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Rendina
authors.forename: Luigi
authors.initials: L
authors.lastname: Gennari
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: De Filippo
authors.forename: Daniela
authors.initials: D
authors.lastname: Merlotti
authors.forename: Enrico
authors.initials: E
authors.lastname: de Campora
authors.forename: Flavio
authors.initials: F
authors.lastname: Fazioli
authors.forename: Gioacchino
authors.initials: G
authors.lastname: Scarano
authors.forename: Ranuccio
authors.initials: R
authors.lastname: Nuti
authors.forename: Pasquale
authors.initials: P
authors.lastname: Strazzullo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mossetti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004777:Environment; D005260:Female; D020022:Genetic Predisposition to Disease / Q000453:epidemiology; D005870:Giant Cell Tumors / Q000453:epidemiology / Q000209:etiology / Q000235:genetics; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010001:Osteitis Deformans / Q000150:complications / Q000453:epidemiology* / Q000235:genetics; D012516:Osteosarcoma / Q000453:epidemiology / Q000209:etiology / Q000235:genetics; D015995:Prevalence