Epidemiological, clinical and genetic characteristics of Paget's disease of bone in a rural area of Calabria, Southern Italy

Background. The prevalence of Paget's disease of bone (PDB) is unknown in peninsular southern Italy, although an elevated clinical severity of the disease was reported in patients from Campania. Aim. This study was performed to evaluate the epidemiological and genetic characteristics of PDB in a rural area of Calabria, the southernmost region in the Italian peninsula. Subjects and Methods. We examined 1068 consecutive pelvic radiographs of patients older than 40 years referred for any reason to the "Spinelli" Hospital, Belvedere Marittimo, from January 1st 2004 to 31 December 31st 2006. In subjects with radiological findings of pelvic PDB, a 99mTC-MDP bone scan and the sequence analysis of the sequestosome 1 (SQSTM1) gene were subsequently performed. Results. In the examined geographic area, the crude radiographic prevalence of pelvic PDB was 0.74% (8/1068; M:F 5:3, mean age 71.6 +/- 13.1 years) whereas the estimated overall prevalence of PDB between 0.82% and 1.21%. PDB patients from Calabria showed clinical characteristics similar to those reported in patients from Campania. The disease was also frequently complicated by osteoarthritis and the right side of the body was more affected than the left. The SQSTM1 gene analysis revealed the presence of a novel missense mutation (M401V) in exon 8 in one subject with a familial and aggressive form of PDB Conclusion. The study results confirmed that patients with PDB from rural districts of Southern Italy show an earlier onset and an increased clinical severity of the disease that appears mostly independent from the presence of germinal SQSTM1 mutations.