Abstract
Paget’s disease of bone (PDB) is the second commonest metabolic bone disorder in the UK after osteoporosis and is both underdiagnosed and undertreated. PDB is often found incidentally on plain X-rays. There is effective treatment so identification of affected individuals is important. The aim was to conduct an audit to determine what proportion of individuals with X-ray evidence of PDB were referred to secondary care. A retrospective audit of X-rays reports in men and women over 55 years of age was undertaken over 18 months searching for the key word “Paget’s.” The images of possible cases were reviewed and the presence of PDB confirmed. The proportion already known to secondary care was determined and those that had had isotope bone scans and treatment. Data recorded included site of lesion, age, gender, level of total alkaline phosphatase (ALP) and complications. A total of 68,873 X-rays were screened and 43 cases found. Pelvic images had the highest proportion of positive findings at 0.2% and 65% of the cases. 74% had not been referred to secondary care. The mean age was 86.7 years (range 65–95) and the ALP was elevated in 65% with a mean of 189u/L (range 47–804u/L). In 33 individuals, PDB had been recorded in the reports of previous X-rays. The rate of referral for specialist care remains low. The prevalence of the condition appears to be falling.
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Data Availability
Data were collected as part of an internal audit at James Cook University Hospital, Middlesbrough.
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Acknowledgements
The authors would like to thank the coding staff of the radiology department at James Cook University Hospital, Middlesbrough for undertaking the search of X-ray reports. We would also like to thank Drs. Afshin Ansari and Siddique Ahmed consultant radiologists for their help in confirming the presence of Paget’s disease of bone on the cases identified.
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SPT audit design, data extraction and analysis and writing. JAW data analysis and writing.
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Dr. Walker has no conflicts of interest. Dr. Tuck is a trustee of the Paget’s Association and has received funding from them for research into Paget’s disease of bone.
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Walker, J.A., Tuck, S.P. Paget’s Disease of the Bone: Patterns of Referral to Secondary Care Following Diagnosis on X-rays. Calcif Tissue Int 108, 634–639 (2021). https://doi.org/10.1007/s00223-020-00800-5
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DOI: https://doi.org/10.1007/s00223-020-00800-5