Mohan, V.

Shefali, Palkar

English

Publications of the IAS Fellows

© JAPI • VOL. 54 • JULY 2006 www.japi.org 585
Correspondence
Paget’s Disease in Diabetic Subjects
Sir,
Paget’s disease or osteitis deformans is a chronic
disorder of unknown etiology, resulting in replacement
of compact bone by vascular spongy bone due to
excessive breakdown and formation of disorganized
bone tissue. The probable causes are abnormal gene
expression or viral infection. Paget’s disease is diagnosed
on the basis of radiological evidence (X-rays and bone
scan) and biochemical parameters (elevated serum
alkaline phosphatase levels). Paget’s disease is more
prevalent in Western countries where the prevalence is
around 3 in people over 40 years of age and the male to
female ratio is 3:2. It is considered to be rare in Asian
countries.1
An earlier study on Paget’s disease revealed that the
prevalence of diabetes among affected individuals was
lower when compared to those unaffected with Paget’s
disease.2 However, both diabetes mellitus and Paget’s
disease are metabolic disorders. Evidences suggests that
bone metabolism is altered in diabetic subjects. Although,
there is no literary documentation of any association
between these two disorders, both the diseases have been
hypothesized to have an immunological and genetic
basis. In our clinical practice, we observed that many
diabetic patients visiting our centre, had unexplained
elevated levels of serum alkaline phosphatase (ALP).
Hence, we conducted a retrospective study to assess the
prevalence of Paget’s disease among diabetic subjects
registered at our centre in order to evaluate any presence
of any association between the two diseases. The study
protocol is outlined in Fig. 1.
Out of 28732 (18930 males and 9802 females)
consecutive diabetic patients who had liver function
tests (LFT) done at our centre, 298 (198 males and 100
females) had ALP levels ³500 IU/L (the normal value for
ALP in our lab is 350 IU/L). Of these 298 patients, 87 (60
males and 27 females) had isolated elevated serum ALP
levels with no other abnormal biochemical changes in
LFT. On reviewing the case details of these 87 subjects,
19 (15 males and 4 females) were found to be known
cases of Paget’s disease undergoing treatment for the
same. These patients were diagnosed by an
endocrinologist to have Paget’s disease on basis of
persistently elevated serum ALP levels, X-rays and bone
scans. These confirmed cases have been treated with Inj.
Palmidronate and are being followed up by the
endocrinologist and they are doing well. The prevalence
of known Paget’s disease in the total diabetic population
visiting our center is therefore, 19/28732 (0.066%), which
includes 79% males (n=15) and 21% females (n=4). While
categorizing according to age, it was interesting to note
that all the subjects with known Paget’s disease were
above 50 years of age.
Though the remaining 68 patients (45 males and 23
females) with elevated ALP levels had no further
investigations to confirm Paget’s, one cannot rule out
the possibility that some of them may be affected by
Paget’s disease. Other causes of isolated elevated serum
alkaline phosphatase levels include chronic active
hepatitis, obstructive jaundice, pregnancy, bone disease,
drug toxicity and inflammatory bowel disease. However,
none of these patients had any clinical evidence of these
conditions.
We would like to suggest that the Paget’s disease of
the bone should be looked for in elderly diabetic patients,
especially in those who have isolated elevation of serum
ALP levels.
Shefali Palkar, V Mohan
MV Diabetes Specialities Centre and Madras Diabetes
Research Foundation, Gopalapuram, Chennai - 600 086, India.
Received : 9.12.2003; Accepted : 8.5.2004
REFERENCES
1. Stephan MK, Lees S. Disorders of bone formation and
resorption. In: Edward R, Daniel F (eds): Scientific American
Medicine. New York, Scientific American Inc. 1995;2:15-6.
2. Siris ES. Epidemiological aspects of Paget's disease: family
history and relationship to other medical conditions. Semin
Arthritis Rheum 1994;23:222-5.
Greater Auricular Nerve Abscess in
Borderline Tuberculoid Leprosy
Masquerading as Jugular Vein Thrombosis
Sir,
Leprosy is a unique infectious disease with wide
spectrum of signs and symptoms. It is a great mimicker.Fig. 1 : Schematic diagram depicting the study protocol.


Paget's disease in diabetic subjects

http://repository.ias.ac.in/92718/1/22-p.pdf

Paget's disease in diabetic subjects

Abstract

Similar works

Full text

Available Versions

Publications of the IAS Fellows