A possible case of Paget’s bone disease from the Identified Skeletal Collection of Évora, Portugal (20th century)

Abstract

Paget’s disease is a chronic metabolic disorder that interferes with bone remodeling, resulting in disorganized bone structure. This paper presents the study of a skeleton, from the Collection of Identified Skeletons from Évora, belonging to a 88 years old female who died in 1987. Various lesions were registered, such as: thickening and deformation of the inner and outer frontal tables, with a rough surface; bone thickening at the vortex and inion; and a “cotton-wool” appearance at the diploë. Within the long bones, the tibiae and femurae were the most affected. The bone thickening resulted in irregular bone surface
and diaphysis curvature, and the right tibia showed a characteristic saber tibia shape. The radiographic analysis revealed sclerotic cortical bone at the tibiae and femurae. Woven bone and generalized porosity was observed in the coxae, sacrum and lumbar vertebrae. Both ilia were thickened. For the differential diagnosis, different conditions like osteomalacia, Paget’s bone disease, syphilis, bone leontiasis and hyperostosis frontalis interna were considered. However, considering the lesions observed, Paget’s disease seems the most probable diagnose.