Paget disease of the spine: an evaluation of 101 patients with a histomorphometric analysis of 29 cases

Abstract

Introduction Paget's disease of bone (PDB) is the second most frequent metabolic bone disease with the spine being a common site of manifestation. Still, neither the disease's etiology nor reasons for its manifestation at preferred skeletal sites are understood. The aim of the current study was therefore to perform a histologic and histomorphometric analysis of PBD biopsies of the spine to achieve a more detailed understanding concerning PDB activity and characteristics. Materials and methods Out of 754 cases with histologically proven PDB, 101 cases were identified to have involvement of the spine. A total of 29 individual vertebral body biopsies were available for histologic and histomorphometric analysis and were compared to age-and sex-matched spinal bone specimens obtained from skeletal-intact individuals at autopsy.Histomorphometric results were correlated with vertebral body height, disease location and iliac crest biopsies.

Vertebral involvement in Paget's disease: Morphological classification of CT and MR appearances

“…PD was first described in 1877 by Sir James Paget in 5 patients [7,8]. PD is a common disease whose prevalence increases with age from about 1% in adult Caucasians aged 40 to 50 years to 10-11% after 80 years of age [9][10][11][12].…”

Bone tissue engineering and regenerative medicine: Targeting pathological fractures

“…The pathological environment of bone diseases alters not only bone cell activity but also the morphology and concentration of osteoblastic and osteoclastic cells. In examining the limited histomorphometric studies, a range of precursor bone cell ratios for physiological and bone diseases was observed (Table ) . Table lists the number of osteoclasts and osteoblasts per millimeter of bone surface, following the standard of histomorphometry defined by the American Society for Bone and Mineral Research .…”

“…Furthermore, histology shows morphology differences, as compared with normal cells, of osteoclasts and osteoblasts involved in Paget's disease. Advances in understanding the cellular etiology of common and rare bone diseases will reveal the morphological abnormalities and osteoclast to osteoblast ratios specific to the particular disease state …”

“…47,[56][57][58] Table I lists the number of osteoclasts and osteoblasts per millimeter of bone surface, following the standard of histomorphometry defined by the American Society for Bone and Mineral Research. 56,57 From the number of osteoclasts and osteoblasts per millimeter of bone surface, the cell ratio was calculated. The ratios indicate a range of osteoclast to osteoblast cell ratio variability in the disease states, a key finding for simulating pathological bone environment in coculture.…”

“…Advances in understanding the cellular etiology of common and rare bone diseases will reveal the morphological abnormalities and osteoclast to osteoblast ratios specific to the particular disease state. 47,[56][57][58] For patients with bone diseases, the inherent increased risk of bone fractures is devastating, including increased complications in fracture healing and management. 3,51,[59][60][61][62] In the case of osteoporotic fractures, prevalence of fractures in the spine and proximal femur are higher in older patients as compared to younger patients, with high risk for distal radial fractures.…”