To the Editor:

Rogers et al.(1) presented data on the prevalence of Paget's disease of bone (PDB) in an archeological population comprising 2770 individuals from northeast England in the Journal. Their study showed an increase in the rate of the disease over time. In March 2004 Waldron(2) concluded after recalculation of the data from Rogers et al.(1) that the disease prevalence had not changed over the 1500 years covered by these burials. We now finished a study on a large skeletal assemblage comprising >8500 individuals from central Europe that provided the opportunity to examine the prevalence of PDB over a period of five millennia of human history (5600 BP to 1500 AD). The prevalence of PDB in our archeological population was only 0.03% (entry criteria as described in ref. 1), with no occurrence of pagetic bones before 1400 AD. We consider this a valid estimation, because PDB cannot be overlooked in skeletal material and because it is based on the greatest number of skeletal remains examined to date. Although PDB was first described in 1877 by the British surgeon Sir James Paget (1814–1899),(3) PDB is in fact a very old condition with few (but controversially discussed) cases being known from the archeological record.(1) Today, it is a fairly common disease with ∼1–3% in middle and advanced adulthood being affected.(4) The infrequency of PDB in our study collection remarkably contrasts the figures of today's disease prevalence. Despite environmental factors playing a role in the etiology of PDB, we favor the explanation that the late-onset and slowly developing manifestation of PDB prevented people in former times from affliction. Whereas only a few centuries ago the average life expectancy was <30 years, it is now at >75 years in industrialized countries. In our subset of specimens dating from the early Middle Ages, we determined a percentage of only 26% being >40 years (40–52 years maximum), whereas for modern populations, this figure is 84%. Consistently, reports of low prevalence of PDB suggest that the disease is uncommon in Africa, where people die earlier because of unfavorable living conditions.(5) The longer human life spans, including a prominent proportion of elderly, enables PDB to appear more frequently nowadays. Our study thus contrasts the recent conclusion published by Waldron,(2) but may grossly illustrate spatial and temporal differences in the disease etiology of PDB.


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  • 1
    Rogers J, Jeffrey DR, Watt I 2002 Paget's disease in an archeological population. J Bone Miner Res 17: 11271134.
  • 2
    Waldron HA 2004 Recalculation of secular trends in Paget's disease. J Bone Miner Res 19: 523.
  • 3
    Paget J 1877 On a form of chronic inflammation of bones (osteitis deformans). Med Chir Trans 66: 37.
  • 4
    Kanis JA 1991 Pathophysiology and Treatment of Paget's Disease of Bone, 1st ed. Martin Dunitz, London, UK.
  • 5
    Pompe Van Meerdervoort HF, Richter GG 1976 Paget's disease of bone in South African Blacks. S Afr Med J 50: 18971899.