The data that Pusch and Czarnetzki present are interesting but can by no means be taken to show that Paget's disease of bone (PDB) has increased in recent years. Their letter contains one error of fact and dubious epidemiology.
The error is in asserting that PDB “cannot be overlooked in skeletal material,” because it most certainly can unless all the bones are X-rayed. In the original paper of Rogers et al.,(1) a number of cases of PDB were found after bones that appeared normal (with respect to PDB) were X-rayed for other purposes.
Their dubious epidemiology stems from the fact that they seem to be comparing the crude prevalence in their assemblage with the crude prevalence in the modern population. Quite apart from the problems that arise in comparing data from the dead with those from the living,(2) the correct comparison should be with the use of age- and sex-specific prevalence, and this does not seem to have been carried out. The most plausible explanation for their findings is clearly to be found in the apparently young age at which those making up the assemblage died. I do agree that the greater expectation of life now is the reason for PDB appearing to be more frequent; whether there is any real difference in prevalence, when adjusted for age, remains to be seen. I hope that the authors will provide us with further, more robust, data in the future.