POLYOSTOTIC PAGETS-DISEASE - A SEARCH FOR LESIONS OF DIFFERENT DURATIONS AND FOR NEW LESIONS

We conducted a medical record-based study of 169 patients with polyost otic involvement identified among 200 Paget's disease patients. Follow -up was 15 to 41 years in 31 cases. The pelvis was the only bone that was more likely than not to be involved bilaterally. All the other pai red bones were more likely to be involved unilaterally and when both s ides were involved the two lesions were very often frankly asymmetric. In a given patient, the duration of the various pagetic lesions, esti mated from their size and from data provided by an earlier study on th e rate of progression of pagetic lesions, was similar in some cases an d showed marked differences in others. Aggregation of the lesions into two or three disease duration groups was seen in some patients, sugge sting that Paget's disease may occur in two or three waves. When we re viewed the radiographs from 30 patients with a mean follow-up of 23 ye ars, we found new lesions in ten patients. However, a review of bone s cans from 18 patients with a mean follow-up of 11 years failed to unco ver any firm evidence of new lesion development, perhaps because all t hese patients received bisphosphonate therapy (etidronate, tiludronate , pamidronate). We also found data suggesting that the disease process spread across a joint in some patients, even in the absence of degene rative joint disease. In particular, in several cases an extensive pag etic lesion was seen on one side of a joint and a considerably smaller lesion on the other side.