Osteoporosis International

, Volume 24, Issue 2, pp 443–450 | Cite as

Secular changes in Paget’s disease: contrasting changes in the number of new referrals and in disease severity in two neighboring regions of Spain

  • L. Corral-Gudino
  • J. García-Aparicio
  • M. D. Sánchez-González
  • J. A. Mirón-Canelo
  • J. F. Blanco
  • S. H. Ralston
  • J. del Pino-Montes
Original Article



We studied the changes in the number of new referrals with Paget’s disease of bone (PDB) and severity of PDB in a high prevalence focus and its neighboring region. Referral of patients changed only in the high prevalence focus. The severity of PDB decreased in both regions. These results could suggest the effects of an environmental influence on disease activity.


The prevalence and severity of PDB have decreased in several countries over recent years. We previously reported a high radiological prevalence of PDB in Vitigudino. Here we sought to determine if secular changes in the number of new referrals and severity of PDB had occurred over recent years.


We studied 280 patients with clinically diagnosed PDB who were evaluated at a regional referral center for metabolic bone disease between 1986 and 2009. Changes in the number of new referrals were calculated by relating these data to the number of subjects at risk as determined by population registers. Trends in disease severity were analyzed with alkaline phosphatase (ALP) activity and disease extent on scan.


Referrals from the Vitigudino region increased substantially between 1986 and 2003 but fell markedly between 2004 and 2009, although by this time there had been depopulation of the region due to emigration. No significant changes in the rates of referral occurred in the remainder of Salamanca. ALP activity and disease extent decreased in Salamanca, but only ALP activity decreased in Vitigudino. Referrals rate and severity of PDB in Vitigudino were greater than in the remainder of Salamanca.


Referral of patients with clinically diagnosed PDB has remained stable for most of Salamanca during the past 24 years, but substantial changes have been observed in Vitigudino. In agreement with other reports, the severity of PDB has decreased in both regions consistent with the effects of an environmental influence on disease activity.


Cohort studies Diagnosis Epidemiology Incidence Paget’s disease 



Alkaline phosphatase


Confidence interval


Paget´s disease of bone


Renier Anatomic Index


Vitigudino high prevalence focus


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • L. Corral-Gudino
    • 1
  • J. García-Aparicio
    • 2
  • M. D. Sánchez-González
    • 3
  • J. A. Mirón-Canelo
    • 4
  • J. F. Blanco
    • 5
  • S. H. Ralston
    • 6
  • J. del Pino-Montes
    • 7
  1. 1.Department of Internal Medicine, RETICEFHospital el BierzoLeonSpain
  2. 2.Department of Internal Medicine, RETICEFHospital Universitario de SalamancaSalamancaSpain
  3. 3.Department of RheumatologyHospital Universitario de SalamancaSalamancaSpain
  4. 4.Department of Preventive Medicine, Public Health’s and MicrobiologyUniversidad de SalamancaSalamancaSpain
  5. 5.Department of TraumatologyHospital Universitario de SalamancaSalamancaSpain
  6. 6.Institute of Genetics and Molecular Medicine, Western General HospitalUniversity of EdinburghEdinburghUK
  7. 7.Department of Rheumatology, RETICEFHospital Universitario de SalamancaSalamancaSpain

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