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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 bone is a Diagnosis metabolic bone disease 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 bone resorption 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 bones 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