The potential for over diagnosis of Paget's disease of bone using macroscopic analysis

Paget's disease of bone in the patient presented with a bowed leg

Key Clinical Message

In dealing with bowed limbs along with increased alkaline phosphatase (ALP), even if the typical changes to the face are not very noticeable at first glance, Paget's disease of the bone (PDB) should be suspected, and the necessary investigations should be carried out to confirm the diagnosis.

Abstract

Paget's disease of the bone (PDB) is the second most prevalent metabolic bone disorder worldwide with disorganized bone remodeling. Here, a patient is presented with pain and bending of the right leg, whose skull and forehead changes are not noticeable at first glance, but with clinical suspicion and additional diagnostic evaluations, PDB diagnosis is confirmed for the patient.

The frequency and macromorphological classification of abnormal blood vessel impressions and periosteal appositions of the dura mater in an early modern osteological collection from Poland

OBJECTIVE

The macromorphological characteristics and frequency of endocranial abnormal blood vessel impressions (ABVI) and periosteal appositions of dura mater (PADM), and their association with sex, age-at-death and scurvy-like lesions were studied. The possible etiologies of these lesions were discussed.

MATERIALS

A total of 144 adult skulls excavated from an early modern (16th-19th c. CE) cemetery at the Czysty Square in Wrocław (Poland) were examined, most of which were intact.

METHODS

The endocranial surface was inspected with an endoscope for the presence, location, and severity of ABVI and PADM. Frequencies of ABVI and PADM were grouped by sex and age-at-death.

RESULTS

A little more than a half (53.5 %) of the examined skulls were affected by ABVI and/or PADM. PADM were more frequent in females. However, both alteration types occurred with similar frequencies across all age-at-death categories.

CONCLUSIONS

The high frequency of ABVI and PADM suggests that meningeal infections and/or hemorrhage among inhabitants of early modern Wrocław, especially in females, were common.

SIGNIFICANCE

The paper emphasizes the need for using an endoscope in standard anthropological analysis of intact skulls, as it allows for a nondestructive inspection of the endocranial surface.

LIMITATIONS

The endoscope did not allow for an accurate examination of the middle cranial fossa.

SUGGESTIONS FOR FURTHER RESEARCH

Comparative studies with other historical populations are necessary to better understand the possible etiologies of macromorphological and demographic characteristics of ABVI and PADM.