Asymptomatic Paget’s bone disease in ethnic Thais: a series of four case reports and a review of the literature

Abstract

Paget's bone disease is quite common in some parts of Europe and countries inhabited by European emigrants, but it is rare in Asia. There have been only 13 reported cases in Southeast Asia, including one reported case from Thailand. Half of the previously reported cases had bone symptoms and the other half were asymptomatic, but were incidentally discovered when patients were being investigated for other medical problems. Here are reported cases of four asymptomatic patients who presented elevation of serum alkaline phosphatase during routine annual medical checkups. All patients were of Chinese descent and all cases were proven by biopsy. Based on this experience, we are of the opinion that a substantial number of unrecognized cases of Paget's disease exist among ethnic Thais. We feel that they would be revealed if clinicians were alerted of its presence and if they included it as a possible diagnosis together with metastasis and osteoporosis when examining bone lesions or when results for elevated serum alkaline phosphatase are detected during routine checkups. We also anticipate that a higher prevalence of this disease may occur in future Thai generations due to the addition of offspring from Asian-European intermarriages to offspring of Chinese descent in the ethnic Thai population.

Clinical Characteristics and Pathogenic Gene Identification in Chinese Patients With Paget’s Disease of Bone

“…Some studies reported intranational regional differences (4-7) and mainly affects people over 55 years (3,8,9). However, the disease is extremely rare in Asia and Africa (1,2,(10)(11)(12)(13). For instance, the incidence rate in Japan is merely 0.00028% (2).…”

“…Therefore, it is imperative to determine the genetic etiology of PDB and provide guidance for efficient molecular diagnosis. Considering the different genetic background between Chinese and Caucasian population (1,(10)(11)(12)14), the exploration of potential pathogenic genes of PDB in Chinese population also beneficial to explain the pathogenesis of PDB.…”

Paget’s disease of the jaws: Histopathological features of a series of 31 cases

“…It occurs in patients over the age of 55 years and is more prevalent in men (M:F ratio: 2:1) 5,6 . PDB has an unusual geographic distribution, with an increased incidence in the United Kingdom, Germany, France, New Zealand, and Australia 6,7 , and being less common in China, Japan, India, Southeast Asia and America [8][9][10][11][12][13] . The incidence and severity of Paget's disease has decreased over the last 35 years [14][15][16][17] .…”

Paget disease of bone among hospitalized patients in Poland

“…In the USA, approximately 1-2% of the population are affected by PDB, with the northeastern region showing the highest prevalence [14]. The prevalence rate of PDB was reported to be low in Japan (0.00028%) [15] and is believed to be a rare disease in Asia [16,17].…”