Paget's disease of bone: the anatomical distribution.

Osteitis deformans has hitherto been regarded as a bone disease of unknown aetiology, but epidemiological studies have raised the possibility of an environmental factor. From the epidemiological studies, X-Rays of 1864 patients with Paget's disease were available for examination of the skeletal distribution of the disease. The epidemiological surveys were based upon examinations of X-Rays covering the lumbar spine, pelvis and upper ends of the femora, and all other X-Ray examinations on the patients showing Paget's disease were also studied for evidence of the disease outside the primary sites. There is a preference for the lower half of the body, and a distribution of the disease in the lumbar and dorsal vertebrae similar to spondylosis; a peri-articular origin of the disease is apparent in long bones, and there is a tendency for the right side of the body to be affected more than the left. The radiological distribution has been supported by radio-nucleide studies in a further 50 patients. In general, the vascular axial skeleton is affected, and it is postulated that an environmental factor is being transported by the blood to bone. Bone stress may then stimulate the changes of osteitis deformans.