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Banaganapalli B, Fallatah I, Alsubhi F, Shetty PJ, Awan Z, Elango R, Shaik NA. Paget's disease: a review of the epidemiology, etiology, genetics, and treatment. Front Genet 2023; 14:1131182. [PMID: 37180975 PMCID: PMC10169728 DOI: 10.3389/fgene.2023.1131182] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 04/17/2023] [Indexed: 05/16/2023] Open
Abstract
Paget's disease of bone (PDB) is the second most prevalent metabolic bone disorder worldwide, with a prevalence rate of 1.5%-8.3%. It is characterized by localized areas of accelerated, disorganized, and excessive bone production and turnover. Typically, PDB develops in the later stages of life, particularly in the late 50s, and affects men more frequently than women. PDB is a complex disease influenced by both genetic and environmental factors. PDB has a complex genetic basis involving multiple genes, with SQSTM1 being the gene most frequently associated with its development. Mutations affecting the UBA domain of SQSTM1 have been detected in both familial and sporadic PDB cases, and these mutations are often associated with severe clinical expression. Germline mutations in other genes such as TNFRSF11A, ZNF687 and PFN1, have also been associated with the development of the disease. Genetic association studies have also uncovered several PDB predisposing risk genes contributing to the disease pathology and severity. Epigenetic modifications of genes involved in bone remodelling and regulation, including RANKL, OPG, HDAC2, DNMT1, and SQSTM1, have been implicated in the development and progression of Paget's disease of bone, providing insight into the molecular basis of the disease and potential targets for therapeutic intervention. Although PDB has a tendency to cluster within families, the variable severity of the disease across family members, coupled with decreasing incidence rates, indicates that environmental factors may also play a role in the pathophysiology of PDB. The precise nature of these environmental triggers and how they interact with genetic determinants remain poorly understood. Fortunately, majority of PDB patients can achieve long-term remission with an intravenous infusion of aminobisphosphonates, such as zoledronic acid. In this review, we discuss aspects like clinical characteristics, genetic foundation, and latest updates in PDB research.
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Affiliation(s)
- Babajan Banaganapalli
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ibrahim Fallatah
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fai Alsubhi
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Preetha Jayasheela Shetty
- Department of Biomedical Sciences, College of Medicine, Gulf Medical University, Ajman, United Arab Emirates
| | - Zuhier Awan
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ramu Elango
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Noor Ahmad Shaik
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Princess Al-Jawhara Al-Brahim Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia
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Hasan TS, Faeq AK. Paget’s disease of bone: the first case reported in Iraqi Kurdish. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2023. [DOI: 10.1186/s43166-023-00185-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Abstract
Background
Paget’s disease of bone (PDB) is a chronic bone disorder which insidiously evolves parallel with the aging process. The affected bone has a distinct imaging appearance, and the clinical manifestations are variable. This disease is ubiquitous among people of Anglo-Saxonian origin. However, it is rarely reported among Asian descents.
Case presentation
Here, the first diagnosed case of Paget’s disease of bone in an Iraqi Kurdish patient, a gentleman in his seventh decade of life underwent sectional imaging for evaluation of spine hopefully to find a potential musculoskeletal or neurological culprit behind his back discomfort. Biochemical confirmation tests were demanded based on the state of the art of the typical radiological judgment, perhaps negating pathological tissue affirmation. Marked geographical variation of the disease occurrence made it seldom to encounter such entity in the Middle East, particularly in Iraq. To the author’s knowledge, scarce cases have been described in Iraq, none in the Kurdish population.
Conclusion
This case report elicits an extremely rare metabolic osseous disease that was radiologically diagnosed at venture when bone window computed tomography (CT) is performed for an unrelated indication.
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Antonelli MJ, Magrey M. Sacroiliitis mimics: a case report and review of the literature. BMC Musculoskelet Disord 2017; 18:170. [PMID: 28431581 PMCID: PMC5401462 DOI: 10.1186/s12891-017-1525-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/07/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Radiographic sacroiliitis is the hallmark of ankylosing spondylitis (AS), and detection of acute sacroiliitis is pivotal for early diagnosis of AS. Although radiographic sacroiliitis is a distinguishing feature of AS, sacroiliitis can be seen in a variety of other disease entities. CASE PRESENTATION We present an interesting case of sacroiliitis in a patient with Paget disease; the patient presented with inflammatory back pain which was treated with bisphosphonate. This case demonstrates comorbidity with Paget disease and possible ankylosing spondylitis. We also present a review of the literature for other cases of Paget involvement of the sacroiliac joint. CONCLUSIONS In addition, we review radiographic changes to the sacroiliac joint in classical ankylosing spondylitis as well as other common diseases. We compare and contrast features of other diseases that mimic sacroiliitis on a pelvic radiograph including Paget disease, osteitis condensans ilii, diffuse idiopathic skeletal hyperostosis, infections and sarcoid sacroiliitis. There are some features in the pelvic radiographic findings which help distinguish among mimics, however, one must also rely heavily on extra-pelvic radiographic lesions. In addition to the clinical presentation, various nuances may incline a clinician to the correct diagnosis; rheumatologists should be familiar with the imaging differences among these diseases and classic spondylitis findings.
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Affiliation(s)
- Maria J Antonelli
- Case Western Reserve University, MetroHealth Medical Center, Divison of Rheumatology, 2500 MetroHealth Dr., Cleveland, OH, 44109, USA.
| | - Marina Magrey
- Case Western Reserve University, MetroHealth Medical Center, Divison of Rheumatology, 2500 MetroHealth Dr., Cleveland, OH, 44109, USA
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Elshafie O, Alsaffi N, Hussain S, Woodhouse N. Paget's Disease in an Omani: Long-term Improvement Following a Single Injection of Zoledronic Acid. Oman Med J 2016; 31:146-9. [PMID: 27168927 DOI: 10.5001/omj.2016.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Paget's disease of bone is a patchy skeletal disorder characterized by an increase in bone resorption and formation in the affected areas. It affects up to 3% of individuals of Anglo-Saxon origin over the age of 40 years but is rare in Arabs. Although most patients are asymptomatic, a variety of symptoms and complications may develop directly from bone involvement or secondarily to compression by bone expansion and increased blood flow. The disease can be treated by using medications that inhibit bone resorption, such as calcitonin and the bisphosphonates. Here we describe the case of an Omani patient with the disease, involving the skull, spine, pelvis, and tibia. He presented to the endocrine clinic in Sultan Qaboos University Hospital with a six-year history of headache, bone pain, progressive skull enlargement, and left-sided deafness. His alkaline phosphatase (ALP) level was 1500 U/L. His disease responded gradually to six months of subcutaneous and nasal calcitonin followed by a single 5 mg intravenous injection of zoledronic acid. This resulted in a further progressive reduction of his bone pain, skull size, and improvement in his hearing, as well as normalization of his serum ALP levels after one-year. This effect has been sustained for 3 years.
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Affiliation(s)
- Omayma Elshafie
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Samir Hussain
- Department of Radiology, Sultan Qaboos University Hospital, Muscat, Oman
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Griz L, Fontan D, Mesquita P, Lazaretti-Castro M, Borba VZC, Borges JLC, Fontenele T, Maia J, Bandeira F. Diagnosis and management of Paget's disease of bone. ACTA ACUST UNITED AC 2015; 58:587-99. [PMID: 25211441 DOI: 10.1590/0004-2730000002941] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 03/18/2014] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To conduct a literature review on the diagnosis and management of Paget's disease of bone. MATERIALS AND METHODS This scientific statement was generated by a request from the Brazilian Medical Association (AMB) to the Brazilian Society of Endocrinology and Metabolism (SBEM) as part of its Clinical Practice Guidelines program. Articles were identified by searching in PubMed and Cochrane databases as well as abstracts presented at the Endocrine Society, Brazilian Society for Endocrinology Annual Meetings and the American Society for Bone and Mineral Research Annual Meeting during the last 5 years. Grading quality of evidence and strength of recommendation were adapted from the first report of the Oxford Centre for Evidence-based Medicine. All grades of recommendation, including "D", are based on scientific evidence. The differences between A, B, C and D, are due exclusively to the methods employed in generating evidence. CONCLUSION We present a scientific statement on Paget's disease of bone providing the level of evidence and the degree of recommendation regarding causes, clinical presentation as well as surgical and medical treatment.
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Affiliation(s)
- Luiz Griz
- Department of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco, Recife, PE, Brazil
| | - Daniele Fontan
- Department of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco, Recife, PE, Brazil
| | - Patricia Mesquita
- Department of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco, Recife, PE, Brazil
| | - Marise Lazaretti-Castro
- Division of Endocrinology, Department of Medicine, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | | | | | - Thyciara Fontenele
- Department of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco, Recife, PE, Brazil
| | - Juliana Maia
- Department of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco, Recife, PE, Brazil
| | - Francisco Bandeira
- Department of Endocrinology, Diabetes and Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco, Recife, PE, Brazil
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Merashli M, Jawad A. Paget's Disease of Bone among Various Ethnic Groups. Sultan Qaboos Univ Med J 2015; 15:e22-e26. [PMID: 25685380 PMCID: PMC4318601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 06/14/2014] [Accepted: 08/21/2014] [Indexed: 06/04/2023] Open
Abstract
Paget's disease of bone (PDB) is a relatively benign disease common among many European populations, including those in the UK, Italy and Spain. However, it appears to be rare among Scandinavians and non-European immigrants living in Europe. The prevalence among Asian populations may be underestimated because a large number of reported cases were discovered incidentally. There is a need for surveys addressing the prevalence rate and consequences of PDB to be carried out in various parts of the world, particularly Asia.
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Chung PYJ, Van Hul W. Paget's Disease of Bone: Evidence for Complex Pathogenetic Interactions. Semin Arthritis Rheum 2012; 41:619-41. [DOI: 10.1016/j.semarthrit.2011.07.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 06/25/2011] [Accepted: 07/08/2011] [Indexed: 11/28/2022]
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