Uptake In Bone Scan Research Articles

Characterizing the unseen: Clinical and radiographic perspectives on unilateral condylar hyperplasia

ObjectivesUnilateral condylar hyperplasia (UCH), marked by progressive condylar growth, occurs between ages 11–30 with unclear etiology. This retrospective study aims to clarify the clinical, radiographic, and demographic features of UCH to improve its diagnosis and treatment. Material and methodsData for all patients included in this study were retrieved from the archive. Inclusion criteria were the diagnosis of UCH supported by a positive bone scan above 10% of condylar uptake in SPECT/CT, the patient's history of progressive facial asymmetry, symptoms confirmed by the orthodontist during follow-up, and clinical and radiological evaluation. Demographic characteristics, along with volumetric and linear measurements, were statistically evaluated. ResultsForty-one patients were included in this study with 70.73% female predominance. Patients were classified as transverse and vertical type condylar hyperplasia (CH) according to their prominent asymmetry characteristics. Eighteen patients were classified as vertical type CH and 23 patients were classified as transverse type CH. Twenty had left-side condylar overgrowth, and 21 had right-side overgrowth. Condylar volume difference was significantly higher in vertical type CH patients compared to transverse type CH (p = 0.004). No correlation was found between growth rate (bone scan uptake ratio) and condylar volume difference in patients with vertical type and transverse type CH patients (p = 0.205). ConclusionParticularly in cases that exhibit a pronounced vertical growth tendency, volumetric and linear measurements can guide the timing and treatment planning process.

A Radiological Scoring System for Differentiation between Enchondroma and Chondrosarcoma.

Simple SummaryBackground: It is challenging to differentiate between enchondromas and atypical cartilaginous tumors (ACTs)/chondrosarcomas. Methods: To evaluate the diagnostic usefulness of radiological findings for differentiation between enchondromas and chondrosarcomas, correlations between various radiological findings and final diagnoses were investigated. Based on the correlations, a scoring system combining these findings was developed. Results: In a cohort of 81 patients, periosteal reaction on X-ray, endosteal scalloping and cortical defect on CT, extraskeletal mass, multilobular lesion, abnormal signal in adjacent tissue on MRI, and increased uptake in bone scan and thallium scan was significantly correlated with final diagnoses. Based on the correlations, a radiological scoring system combining radiological findings was developed. In another cohort of 17 patients, the sensitivity, specificity, and accuracy of the radiological score rates for differentiation between enchondromas and chondrosarcomas were 88%, 89%, and 88%, respectively. Conclusion: Comprehensive assessment combining radiological findings is recommended to differentiate between enchondromas and ACTs/chondrosarcomas.Background: It is challenging to differentiate between enchondromas and atypical cartilaginous tumors (ACTs)/chondrosarcomas. In this study, correlations between radiological findings and final diagnosis were investigated in patients with central cartilaginous tumors. Methods: To evaluate the diagnostic usefulness of radiological findings, correlations between various radiological findings and final diagnoses were investigated in a cohort of 81 patients. Furthermore, a new radiological scoring system was developed by combining radiological findings. Results: Periosteal reaction on X-ray (p = 0.025), endosteal scalloping (p = 0.010) and cortical defect (p = 0.002) on CT, extraskeletal mass (p < 0.001), multilobular lesion (p < 0.001), abnormal signal in adjacent tissue (p = 0.004) on MRI, and increased uptake in bone scan (p = 0.002) and thallium scan (p = 0.027) was significantly correlated with final diagnoses. Based on the correlations between each radiological finding and postoperative histological diagnosis, a radiological scoring system combining these findings was developed. In another cohort of 17 patients, the sensitivity, specificity, and accuracy of the radiological score rates for differentiation between enchondromas and ACTs/chondrosarcomas were 88%, 89%, and 88%, respectively (p = 0.003). Conclusion: Radiological assessment with combined radiological findings is recommended to differentiate between enchondromas and ACT/chondrosarcomas.

Prevalence of wild type ATTR assessed as myocardial uptake in bone scan in the elderly population

BackgroundMyocardial uptake of bone tracers has emerged as useful tool for the early detection of transthyretin amyloidosis (ATTR). The prevalence of wild-type ATTR (ATTRwt) in individuals remains to be established. MethodsAll whole body bone scans performed in individuals ≥ 75 years with no previous clinical suspicion of ATTR were revised in a population-based university hospital over a 7-year period (1509 studies corresponding to 1114 patients; 80.5 ± 4.1 years, 65% males). Positive cardiac uptake was defined according to Perugini score as grade 2 or 3. Heart failure (HF) hospitalizations during the follow-up were obtained from regional administrative databases. ResultsThirty-one patients ≥ 75 years (2.78%) showed cardiac uptake; compared with those without uptake, these patients were older (85 ± 5 vs. 80 ± 4, p < 0.001) and predominantly males (90% vs. 64%, p = 0.005). The prevalence of cardiac uptake was 3.88% in males and 0.77% in females, and increased with age, reaching 13.9% in males≥85 years (2.7% among females). The estimated prevalence for the European standard population ≥ 75 years was 4.15% in males, 1.03% in females and 2.59% in the general population. HF hospitalizations rates were 14% in patients without uptake and 29% in those with cardiac uptake (p = 0.034). After adjusting for age and gender, cardiac uptake was associated with a higher risk of HF hospitalization (OR 2.60, 95%CI 1.09–5.74, p = 0.022). ConclusionsMyocardial uptake in bone scan is very prevalent with ageing, mainly affects males and is associated with an increased risk of HF hospitalization. These findings reinforce ATTRwt as a relevant cause of HF in the elderly.

Low Positive Predictive Value of Bone Scan to Predict Impending Complete Fracture among Incomplete Atypical Femoral Fracture.

BackgroundAlthough bone scan might be useful to detect incomplete atypical femoral fractures (AFFs) earlier than radiographs, there is no study on predicting further progression to a complete fracture among incomplete AFFs. Our purposes are to determine whether bone scan detects impending complete fracture among incomplete AFFs.MethodsWe reviewed 18 patients (20 AFFs) who underwent bone scan at the diagnosis of incomplete AFF and were not treated with prophylactic fixation. A diagnosis of impending complete fracture was made, when the femur completely fractured within 6 months after the scan. We correlated radioisotope uptake with the impending complete fracture to calculate sensitivity, specificity, positive predictive value and negative predictive value of bone scan.ResultsThirteen AFFs (65%, 13/20) showed a positive uptake in bone scan. Among the 13, only one femur was completely fractured within 6 months. None of the 7 femurs without uptake in bone scan fractured. In diagnosing impending complete fracture, the sensitivity of bone scan was 100% and negative predictive value was 100%. However, the specificity (36.8%) and positive predictive value (7.7%) were quite low.ConclusionBone scan has no significant role in detecting the impending complete fracture, and a positive uptake does not mean the necessity of prophylactic fixation of incomplete AFF.

Is intermittent pneumatic compression (IPC) an appropriate method for increasing 99m Tc-MDP uptake in bone scan?

Background: Currently, intermittent pneumatic compression (IPC) is a standard method of lymphedema treatment. Recently, the effect of this modality in patients with limb arterial insufficiency has been researched. It has been suggested that the arterial inflow to the long bones is also increased by IPC. The purpose of this paper is to assess the effect of lower limb IPC on the blood flow as well as delayed bone uptake. Methods: In this prospective study, we evaluated 30 patients who were referred for whole body bone scan to our Nuclear Medicine Department. All the patients had been examined by a vascular surgeon for ruling out any peripheral neuropathy, vasculopathy or ulcer in the lower limbs. Also, all the patients were questioned about hypertension, diabetes mellitus, and other chronic diseases with peripheral complications. Following 925MBq of 99mTc-methylenediphosphonate (MDP) injection, perfusion and blood pool images of both legs as well as static delayed images were done after the completion of IPC. Results: Thirty patients (10 male) with the age range of 30–84 years (mean = 53.4) were included. Radiotracer uptake in flow and blood pool images in the compressed limb was significantly more than the contralateral limb, however, on delayed images, no significant difference was noted between two limbs. Conclusion: Although IPC can significantly increase blood flow of the compressed limb, MDP uptake on the delayed images was not increased. According to this study, IPC may not be useful as a technique to increase releasing chemotherapy drugs or other substances to the bone and promoting bone growth.

Wegener’s Granulomatosis: Extraosseous Uptake in HDP Bone Scintigraphy- A Case Report

Bone scan is most frequently prescribed for evaluation of patients with known malignancy or screening of bony uptake for unexplained body ache. Extraosseous uptake in bone scan is point of interest because sometimes additional information could be found beside skeletal abnormality. Here we discuss an interesting case of extraosseous uptake.Bangladesh J. Nuclear Med. 18(1): 61-63, January 2015

Disseminated Bone Pain Related to Brown Tumors Revealing a Parathyroid Adenoma: A Case Report

Introduction: Primary hyperparathyroidism is a common disease especially in women but rarely discovered by multiple brown tumors with near normal serum calcium. Case report: A 64-year-old manpresented with disseminated bone pain. He had X-rays and a CT scan that objectified lytic lesions. These lesions correspond to multiple areas of intense uptake in bone scan evoking brown tumors. Biology showed calcium at 2.66mmol/l and PTH in serum at 2003µg/l. The diagnosis of parathyroid adenoma was highly suspected that’s why we did a Tc99msestamibi dabble phase parathyroid scan. It showed a left inferior parathyroid adenoma. Conclusion: The scintigraphic imaging is a valuable contribution to the diagnosis of brown tumor, it also allows for the etiologic diagnosis by detecting the nodule parathyroid.

Subchondral bone scan uptake correlates with articular cartilage degeneration in osteoarthritic knees.

The aim of this study was to analyze subchondral bone scan uptake in osteoarthritic knees with reference to subchondral bone microstructure and articular cartilage histology. This cross-sectional, laboratory study evaluated 123 human distal femoral condyle specimens of 67 patients after joint replacement surgery. All patients were preoperatively examined with bone scan of the knee joint. Specimens were evaluated for cartilage histology and micro-computed tomography analysis of subchondral bone. Data between bone scan, histology and micro-computed tomography were statistically analyzed using either coefficient of correlation, Student's t-test or one-way analysis of variance with Tukey post hoc test. Bone scan grading and histological articular cartilage degeneration scores showed significant correlation (r = 0.812, P < 0.001). Both bone scan positive and histologically confirmed osteoarthritis samples showed increase in subchondral trabecular bone volume and thickness, reflected in micro-computed tomography. Overall, positive predictive value (%) of bone scan for osteoarthritic cartilage lesions was 91.9%, and the sensitivity and specificity were 88.3% and 60%, respectively. Histology showed that bone scan has both a high positive predictive and a low negative predictive value for detection of osteoarthritic cartilage lesions. Bone scan uptake correlated with articular cartilage degeneration in osteoarthritic knees. Bone scan may be a useful diagnostic tool that reflects pathologic changes of cartilage in osteoarthritis.

Enchondroma versus Chondrosarcoma in Long Bones of Appendicular Skeleton: Clinical and Radiological Criteria-A Follow-Up.

As of today two types of cartilage tumors remain a challenge even for the orthopedic oncologist: enchondroma (E), a benign tumor, and chondrosarcoma (LGC), a malignant and low aggressiveness tumor. A prospective study of 133 patients with a cartilaginous tumor of low aggressiveness in the long bones of the appendicular skeleton was done to prove this difficult differential diagnosis. Parameters including medical history and radiological and nuclear imaging were collected and compared to the result of the biopsy. A scale of aggressiveness was applied to each patient according to the number of aggressiveness episodes present. A comparison of the results of the biopsy with the initial diagnosis made by the orthopedic oncologist based solely on clinical data and imaging tests was also made. Finally, a management algorithm for these cases was proposed. A statistical significance for LGC resulted from the parameter as follows: pain on palpation, involvement of cortical in either the CT or MRI, and Tc99 bone scan uptake equal or superior to anterosuperior iliac crest. In our series, a tumor scoring 5 points or higher in the scale of aggressiveness can have 50% more chance of being LGC. When compared with the gold standard (the biopsy), surgeon's initial judgement showed a sensitivity of 73.5% and a specificity of 94.1%.

Determination of the painful level in osteoporotic vertebral fractures—Retrospective comparison between plain film, bone scan, and magnetic resonance imaging

BackgroundDetermining the actual painful vertebral level is difficult when evaluating osteoporotic vertebral fracture, especially when there are acute and chronic fractures simultaneously. In this study, we retrospectively evaluated and compared the findings between plain film, bone scan, and magnetic resonance imaging (MRI) in the diagnosis of new fracture in osteoporotic vertebral fractures. MethodsThis is a retrospective clinical study of patients who were diagnosed with osteoporotic vertebral fractures using plain film, bone scan, and MRI within a 1-month interval between February 2008 and December 2012. The findings in plain film, the extent of increased uptake in bone scan, and signal change in MRI were compared to evaluate the actual level of pain. All patients received percutaneous vertebroplasty according to MR finding. Pain scores (visual analog scale) of the study patients were compared prior to and after the procedure. ResultsA total of 52 patients with a mean age of 79.1 years (range 59–92 years) were enrolled in this study, and were treated by vertebroplasty confirmed by MRI. It was observed that patient pain score (visual analog scale) improved from 7.6 to 2.8. Plain film examination revealed 79 vertebrae that were suspected to be compression fractures. Among the suspected vertebrae, 62 showed increased uptake in bone scan, and MRI showed bony edema change in 58 vertebrae. The consistency between bone scan and MRI was 96.9% in patients with single-level suspected fracture on plain film. There was moderate agreement (kappa was 0.56) in patients where multiple levels were noted. Fifteen vertebrae with vacuum cleft sign on plain film showed total concordance in both bone scan and MRI. ConclusionFor patients with single-level compression fracture, the painful level in osteoporotic vertebral fractures can be determined by plain film and bone scan testing. Vacuum cleft sign noted on plain film may be enough to localize the level of pain. However, MRI testing is further needed in multiple osteoporotic vertebral fracture patients.

Lunate intraosseous ganglion cysts and chronic wrist pain- reporting six cases.

Intraosseous ganglion (IOG) cysts rarely have been reported in the carpal bones and lunate is the most common area of involvement. They can present as chronic wrist pain accompanied by a radiolucent lytic lesion in the lunate bone. We provided a retrospective review of six cases of intraosseous ganglion cysts within the lunate bones that all of the patients presented with chronic wrist pain. We retrospectively reviewed the medical records, pathologic reports and imaging files of the six patients who were referred and treated due to chronic wrist pain with final diagnosis of the lunate intraosseous ganglion. All cases were treated by curettage and autologous cancellous bone grafting. There were six patients with final diagnosis of the lunate IOG who received surgical treatment. Four out of six patients were female and the remaining was male. Mean age of the patients was 33 years (22 - 56). Right wrist was involved in four patients. Pain was the chief complain in all patients. Mean time of suffering from the wrist pain till referring to hand clinic for definite treatment was nine months (3 - 24). Mean duration of follow up was 30.6 months (6 - 48). The wrists became pain free after surgical treatment and no graft absorption or recurrences were seen in the control radiographs obtained throughout the follow-up period. Diagnosis of intraosseous ganglion was based on the imaging features and clinical presentation. Although most cases of the lunate bone IOGs are symptom free and found incidentally after wrist imaging performed for other reasons, these lytic lesions should be included in differential diagnosis list of chronic wrist pain especially in the presence of increased uptake in bone scan located on the lunate area.

A case report of xanthogranulomatous osteomyelitis of the distal ulna mimicking a malignant neoplasm

Patient: Male, 59Final Diagnosis: Xanthogranulomatous osteomyelitisSymptoms: Painful swelling in the wristMedication: Drug history of antifulgal agentsClinical Procedure: Excisional biopsySpecialty: RadiologyObjective:Rare diseaseBackground:Xanthogranulomatous inflammation is a chronic inflammatory disease in which bone involvement is extremely rare. Bone involvement of xanthogranulomatous inflammation, termed xanthogranulomatous osteomyelitis (XO), often presents as a mass-like lesion extending to adjacent structures, which can mimic infiltrative carcinoma.Case Report:We present a case of XO in the ulna, which mimicked a neoplasm. A 59-year-old man presented with a 2-month history of painful swelling in the right wrist. Plain radiography and CT showed an osteolytic lesion at the distal ulna. MRI revealed a soft-tissue mass with lobulated margins and contrast enhancement. Intense uptake in bone scan and PET suggested malignancy. An excisional biopsy from the representative area resulted in a pathology diagnosis of XO.Conclusions:Gross and radiologic manifestations of XO can mimic neoplasm. XO generally has benign prognosis, contrary to malignant bone tumor. Therefore, biopsy and histopathological confirmation are necessary for proper management.

A Solitary Bone Lesion in a Patient With Previous Breast Cancer and the Importance of Bone Biopsy: A Case Report and a Review of Guidelines

Introduction Increased radionuclide bone scan uptake in a solitary bony site in patients with known malignancy are common and can be a diagostic problem, given the nonspecificity of bone scintigraphy. Bone s the most common site of metastatic breast cancer recurrence, and approximately 80% of patients with metastatic disease have bone metastases. Bony lesions are usually, but by no means always, ultiple, and, in one study, 98% of solitary bone lesions suspected of eing metastatic subsequently proved to be so. Other investigations, including, in particular, magnetic resonance imaging (MRI) can add to the diagnostic accuracy of isotopic bone scanning, but the definitive diagnosis would be with histologic material obtained at bone biopsy. However, bone biopsy is by no means a routine procedure. Imaging-guided bone biopsy is generally a low-risk procedure, but possible adverse effects range from minor (pain and minor damage to surrounding tissue) to major (localized infection, osteomyelitis, par-

Two-year outcomes of Elektra prosthesis for trapeziometacarpal osteoarthritis: a longitudinal cohort study

The aim of this study was to evaluate clinical and radiographic outcomes of Elektra® trapeziometacarpal prostheses after 2 years. We present a longitudinal cohort study of 19 prostheses for the treatment of Eaton stage II and III osteoarthritis (mean follow-up of 29 months). QuickDASH score, pinch strength and mobility were determined, and radiographs were analysed. Isotope scans were taken in patients with persistent pain or suspected loosening. Although the QuickDASH score was 69 before and 38 after surgery, nine patients had pain at the trapeziometacarpal joint with radiographic osteolysis around the trapezium component and a positive bone scan uptake at subsequent follow-up. The implant was revised in three of these nine patients and another patient underwent surgery for periprosthetic fracture. Only ten of the 19 implants showed no sign of failure. Most problems derived from the trapezium cup. Because of these poor outcomes after only 2 years, we cannot recommend this implant.

Rheumatic manifestations of hematologic malignancies: Correlation with

Objective: To determine the rheumatic manifestations associated with hematologic malignancies namely acute and chronic leukemia, Hodgkin’s and non-Hodgkin’s lymphomas, and multiple myeloma; and the markers correlating with their presence. Methods: Eighty patients with hematologic malignancies (28 leukemia, 28 lymphoma and 24 multiple myelomas) were evaluated and examined for the presence of rheumatic manifestations, clinically, radiologically, and by bone scan. Two groups of controls: clinical and laboratory (80 and 15 healthy individuals from the normal population respectively) were also studied. Routine laboratory tests and bone marrow aspiration were done for all patients, while serum rheumatoid factor (RF), antinuclear antibodies (ANA), creatine phosphokinase (CPK), and serum beta-2 macroglobulin were assessed as a marker for rheumatic manifestations in patients and controls. Results: Rheumatic manifestations were identified in 50 patients with hematologic malignancies (62.5%) and 21 clinical controls (26.3%) (p&lt; 0.001, odds ratio=4.7, and 95% confidence interval=2.4-9.2). Arthralgia and low back pain were the most significantly rheumatic manifestations associated with hematological malignancies in comparison with healthy controls (OR=15.4, and OR=3.4 respectively). Serum beta-2 macroglobulin was elevated in 38 patients (47.5%), rheumatoid factor was positive in 30 patients (37.5%), and ANA was found in 19 (23.7%) with a significant difference between patients and laboratory controls. 60 patients (75%) had radiological findings and 19 patients (23.75%) had an increased uptake in bone scan. Serum beta-2 macroglobulin was positively correlated with rheumatic manifestations (r=0.21, p=0.02), osteopenia in x-rays (r=0.24, p=0.03), and increased uptake in bone scan (r=0.41, p&lt; 0.001). Conclusion: Rheumatic manifestations occur in 62.5% of patients with leukemia, lymphoma, and myeloma, significantly more commonly than in age and sex-matched controls. They may precede the other manifestations of malignancy (31.3%), occur during the course of illness (25%) or follow as a complication of chemotherapy (6.3%). Serum beta-2 macroglobulin is a useful laboratory test, being a marker for the presence of rheumatic manifestations and predicting osteopenia in x-rays and increased uptake in bone scan.

Ectopic Parathyroid Carcinoma Presenting With Hypercalcemic Crisis, Ectopic Uptake in Bone Scan and Obstruction of Superior Vena Cava

A 28-year-old Chinese man diagnosed with hypercalcemic crisis was referred for Tc-99m sestamibi parathyroid imaging, which revealed a massive sestamibi-avid lesion in right-site of upper mediastinum. Contrast-enhanced CT demonstrated the lesion encroached and obstructed bilateral innominate veins and superior vena cava. Tc-99m methylene diphosphonate (MDP) bone scan and SPECT displayed ectopic uptakes in the lungs and stomach. Preoperative suspicion of parathyroid carcinoma prompted an en bloc surgery, which was confirmed in histopathology. Our case showed that although ectopic parathyroid carcinoma causing hypercalcemic crisis, extraskeletal microcalcifications, and great vessel obstruction is rare, parathyroid imaging and bone scan can help solve these diagnostic challenges.

Reversible bone pain and symmetric bone scan uptake in a dialysis patient treated with cinacalcet: a case report

IntroductionThe medical management of secondary hyperparathyroidism in patients with end-stage renal disease involves a combination of dietary restrictions, phosphate binders, active vitamin D analogs, and calcimimetics.Case presentationWe report the case of a 36-year-old Hispanic dialysis patient, originally from Cuba and now residing in the USA, who developed severe bone pain and muscle twitching after starting low dose cinacalcet, despite normal pre-dialysis ionized calcium and elevated parathyroid hormone. The clinical symptoms correlated with increased symmetrical uptake on bone scan that resolved rapidly upon discontinuation of cinacalcet.ConclusionCinacalcet may induce severe bone pain and a unique bone scan uptake pattern in hemodialysis patients.

Fixation extraosseuse du radiotraceur lors de la réalisation d’une scintigraphie du squelette chez un patient atteint de bêta-thalassémie : à propos d’un cas

Red blood cell transfusion, main therapeutic modality of beta-thalassemia, leads to iron overload which may perturb several metabolic ways. The aim of this paper is to illustrate the uptake abnormalities observed on bone scan of thalassemic patients and to discuss mechanisms of extraosseous accumulation of the radiopharmaceutical in this pathology. We report a 16-year-old child suffering from beta-thalassemia major undergoing transfusion therapy. A bone scan was indicated to look for osseous infection. This study revealed a little skeletal uptake and abnormal liver, splenic and renal accumulation. A repeat bone scan, performed three weeks later showed a better skeletal uptake which enabled the discovery of focal abnormalities and made the diagnostic easier. The effect of iron overload on radiopharmaceuticals's uptake in bone scan is known since 1975. Dissociation of 99mTc from the carrier ligand due to the presence of iron excess seems the most plausible hypothesis. Free 99mTc can be bound to other tissular substrates which can explain extraosseous uptake. The normally available pool for bone is reduced and then the skeletal uptake decreased. This report limits considerably the sensitivity of the bone scan. A well-led iron chelation and eventually the use of diuretic drug may guarantee a better quality of bone scan images.

Spontaneous collapse of the tibial plateau: radiological staging

This paper proposes a radiological staging system for necrosis of the tibial plateau, similar to those already developed for the hip and the medial femoral condyle. We retrospectively studied the clinical case histories and radiographic findings of 14 patients (15 affected knees) with histologically proven osteonecrosis of the tibial plateau. Stage I was marked by normal radiograph, but increased uptake in bone scan and subchondral areas of abnormal marrow signal intensity in magnetic resonance imaging (MRI), as reported in other osteonecrosis sites. Stage II was characterised by cystic and sclerotic changes, and stage III fracture of the medial rim of the medial tibial plateau and tibial plateau collapse were present. Stage IV was marked by joint narrowing. These changes appeared earlier and were more pronounced when there was genu varum/valgum or involvement of the lateral tibial plateau. The radiological evolution of the disease appears to follow a four-stage course over a period of roughly one year from the onset of symptoms.

Is clinical expressiveness of Paget’s disease of bone decreasing?

Recent data have suggested secular changes implying a current trend toward decreased clinical severity of Paget’s disease of bone (PD). To test this hypothesis, we conducted a study comparing the characteristics of two groups of PD patients, as disclosed from a sample assessed systematically. The investigation was a hospital-based study of all cases followed up at our unit since 1980. Throughout the follow-up period, diagnosis was based on standard X-ray criteria and the same clinical assessment was applied. Group I (n = 124) represented patients born before 1926, whereas group II (n = 109) included those born after that year. A bone scan performed with 99mTc-EHDP was available for all patients. X-rays of the pelvis and spine, and views of any hot spot observed on the scintigraphy scans were reviewed. The skeletal extent of PD, based on bone scan uptake, was determined by using the index proposed by Coutris. Alkaline phosphatase and hydroxyproline excretion levels were determined in blood and urine, respectively. Baseline characteristics were recorded on a purpose-designed computerized database. The proportion of males (47% in group I vs. 65% in group II; p = 0.007) and the mean (±SD) age at diagnosis (69.0 ± 8.15 vs. 54.3 ± 9.14; p < 0.001) differed significantly between groups. The year of birth showed a strong negative correlation with age at diagnosis ( r = −0.83, p < 0.0001) and a weak, but significant, negative correlation with extent of bone lesion ( r = −0.20; p = 0.002). Likewise, subjects born prior to 1926 showed a greater percentage of affected skeleton cases (9.6 ± 8.01 vs. 7.06 ± 5.79; p = 0.001). Group I individuals who had pelvic and/or femoral bone lesions were more prone to suffer “pagetic coxopathy” (65% vs. 40%; p = 0.003) with “protrusio acetabuli” (32% vs. 17%; p = 0.01), and the percentage of patients showing radiographic Monckeberg-type vascular calcifications (36% vs. 14%; p = 0.0006) was higher than in those born after 1926. No other epidemiologically clinically, or biochemically relevant differences were seen in the crude analysis. Multivariate analysis identified extent of skeletal lesions (OR = 0.76; p = 0.01), age at diagnosis (OR = 0.79; p = 0.008), number of bones involved (OR = 1.53; p = 0.03), and occupation ( p < 0.0001) as the predictive variables linked to year of birth. Our data are consistent with a temporal tendency toward a smaller number of bone lesions and a decreased percentage of instances of affected skeleton. An earlier age at recent diagnosis times and absence of any relevant clinical or biochemical differences seems more likely linked to recent changes in referral and sociological patterns.