Paget's disease of bone in a North African population: clinical, imaging, and therapeutic insights from a Moroccan case series.

BACKGROUND

Paget's disease of bone (PDB) is a non-malignant skeletal disease that has become rare in recent decades. It is characterized by disorganized bone remodeling. Although its presentation varies worldwide, it is infrequently reported in Africans. To our knowledge, this is the first case series of PDB reported from Morocco, highlighting clinical and imaging features in a North African population.

METHODS

A retrospective case series and a literature review. Seven patients were identified during an 8-year period and diagnosed with Paget's disease of bone. Demographic profiles, clinical presentations, laboratory tests, imaging features and therapeutic approaches were collected and analyzed.

RESULTS

The mean age of the seven patients (4 women and 3 men) at disease diagnosis was 60.5. The most affected sites were the spine and the skull. One patient had a monostotic form. Neurological complications were observed in three patients, including blindness due to optic nerve compression and profound hearing loss requiring cochlear implantation. One patient had concurrent bladder cancer, making the differential diagnosis challenging. Six patients had vitamin D deficiency or insufficiency. All patients received intravenous zoledronic acid, with significant clinical and biochemical improvement in the majority of cases. No malignant transformation was observed during follow-up.

CONCLUSION

In this Moroccan series, incidental diagnosis was common and skull/spine involvement predominated, consistent with prior literature. The severity of neurological complications highlights the importance of early recognition and prompt metabolic management in comparable settings. Key Points • Clinical spectrum of Paget's disease of bone in a North African population. • Neurological complications and sensory impairments in Paget's disease. • Imaging features including a "cotton wool" appearance and diagnostic challenges. • Therapeutic outcomes of intravenous zoledronic acid in Paget's disease.