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5-2009 Pagetʼs Disease (Osteitis Deformans) in Archaeological Remains: A Radiographic Differential Andrew D. Wade The University of Western Ontario, [email protected]

Gregory J. Garvin The University of Western Ontario, [email protected]

David W. Holdsworth The University of Western Ontario, [email protected]

Follow this and additional works at: https://ir.lib.uwo.ca/anthropres Part of the Archaeological Anthropology Commons, and the Bioimaging and Biomedical Optics Commons

Citation of this paper: Wade, Andrew D.; Garvin, Gregory J.; and Holdsworth, David W., "Pagetʼs Disease (Osteitis Deformans) in Archaeological Remains: A Radiographic Differential" (2009). Anthropology Presentations. 7. https://ir.lib.uwo.ca/anthropres/7 Pagetʼs Disease (Osteitis Deformans) in Archaeological Remains: A Radiographic Differential

Andrew D Wade1, Gregory J Garvin2, David W Holdsworth3

Department of 1 Anthropology and 3 Schulich School of Medicine and Dentistry, University of Western Ontario & 2 St.Josephʼs Health Care, London Introduction Spine Differential Paget’s disease of is a Diagnosis metabolic of unknown Pelvis Plain film radiographs of the cervical spine show Skull etiology and is the most likely minimal-to-mild sclerosis of the atlas (C1), mild Plain film radiographs Paget’s Disease of Bone [2] disease to cause secondary bone sclerosis of the axis (C2). Cervical vertebrae, C4 cancer; a prevalence that increases of the skull demonstrate regional involvement and C7, are diffusely sclerotic. with age[1]. With the increasing age minimal pathological mild expansion of modern populations, the involvement, with only cortical thickening importance of better understanding the right frontal bone trabecular thickening this disease will likewise increase. trabecular rarification While in vivo tests for the disease demonstrating patchy cannot be performed in skeletal sclerosis laterally. Osteitis Ilii Condensans [5] samples, radiographic views of archaeological remains can provide X increased density of ilium insight into the origins and natural X no trabecular rarification history of the disease. Fibrous Dysplasia This plain film radiograph of the left pubis, expansion of bone demonstrating diffuse sclerosis, well-defined Pagetʼs Disease variable density lucencies, cortical thickening, and significant X ground glass opacity Disrupts bone remodelling [2]: trabecular thickening, was the initial indicator X cortical thinning • increase in of a pathological condition in this individual. • increase in bone formation Metastatic Cancer [5] • formation of weaker osteoid • most common in males over 40 The CT scan of the skull X isolated sclerotic lesions also shows patchy bilateral X irregular bony expansion Untreated it can cause [2]: The CT scan of the cervical sclerosis, with well-defined • bowing of the long spine also reveals greatly surrounding lucency and Hyperphosphatasia [2] constriction of joints • thickened cortex and coarse, cranial thickening. (“Juvenile Paget’s”) • constriction of eyes irregular trabeculae in similar to Paget’s • constriction of brain C4 and C7. • secondary osteosarcoma CT and micro-CT scans of the left pubis also X shortened stature demonstrated greatly increased cortical thickness X skeletal malformation and a dramatic rarification of trabeculae. Methods & Materials Femur

The case discussed here [3] is an Conclusions Plain film radiographs individual from the Grant skeletal This case study and the CT scan of the collection; part of a sample selected demonstrates the power of femora demonstrate for a study of age-related trabecular radiography, particularly CT indications of a and micro-CT, in diagnosing change in the pubis [4]. pathological process pathological conditions such as Paget’s disease of bone. The Individual 669 in the proximal half • 66 year old male of the left femur. The cultural sensitivity and • died of a heart attack importance of archaeological cortex and trabeculae human remains precludes the Plain film x-rays: CT scans : the left femur are use of destructive techniques in • left pubis • left pubis thickened relative to their analysis. Where • both pelves both pelves • Plain film radiographs of the pelves exhibit biochemistry and bone scans are • both femurs • both femurs the right. • spine • spine diffuse sclerosis, well-defined lucencies, cortical also impossible, the ability to • skull • skull thickening, and fewer but thicker trabeculae. Plain film radiographs of the lumbar spine show non-destructively assess the involvement of the 1st and 3rd lumbar vertebrae, thickness and quality of bone is Micro-CT scan: with thickening of both trabeculae and end plates. key to an accurate differential • left pubis diagnosis of Paget’s disease of bone.

Acknowledgments For further Literature cited Scanning time was donated by St. Joseph's Healthcare, information [1] Moore TE, King AR, Kathol MH, El-Khoury GY, Palmer R, Downey PR. 1991. Sarcoma in Paget disease of bone: Clinical, radiologic, and pathologic features in 22 cases. American Journal of Roentgenology 156 : 119-1203 London (CT), by the Toronto Hospital for Sick Children (CR, Please contact [email protected]. [2] Kanis JA. 1998. Pathophysiology and Treatment of Paget’s Disease of Bone, Second edition. Martin Dunitz: London, UK DR, & CT), and by the Robarts Research Institute (micro- Andrew Wade [3] Wade AD, Garvin G, Holdsworth DW. Submitted. CT and micro-CT analysis of a case of Paget’s disease (osteitis deformans) in the Grant skeletal collection. International Journal of Osteoarchaeology CT). We thank Karen Betteridge and Rosemary Miller at c/o Department of Anthropology, [4] Wade AD. 2008. Radiological assessment of age-related change in the trabecular structure of the human os pubis. MA Thesis. University of Western Ontario St.Joseph's, Stephanie Holowka at Sick Kid’s, and Joseph [5] Cushing FR, and Bone HG. 2002. Radiographic diagnosis and laboratory evaluation of Paget’s disease of bone. Clinical Review in Bone and Mineral Metabolism 1(2) : 115-134 Social Science Centre Umoh at Robarts for technical assistance. Skeletal samples University of Western Ontario, were provided by the Grant Skeletal Collection. London, ON, N6A 5C2