The potential for over diagnosis of Paget’s disease of bone using macroscopic analysis

Objective This study explores the validity of Paget’s disease of bone (PDB) reported in unpublished skeletal reports, based on macroscopic analysis alone. Materials The high prevalence of ‘suspected’ Paget’s disease (10.7%) in an early modern sample from St John’s the Evangelist Church in Redhill, Surrey is reassessed. Methods Signs of PDB were examined in 53 well-preserved adults aged 35 + years using macroscopic, radiographic and histological techniques. Results Macroscopic features of PDB were identified in 8 individuals (15%), with 5 individuals later rejected using radiography. Two individuals showed classic radiographic features of PDB, with a third presenting possible features in radiography (5.7%). These three cases were confirmed by histological analysis. Conclusions PDB should not be suggested as a single diagnosis in cases of bone hypertrophy without confirmation using radiography. Significance The growing popularity of ‘big data’ projects and limited collections access means that unpublished cases of PDB are often included in large scale analyses, impacting our understanding of the evolution of this disease. Using macroscopic analysis alone leads to overdiagnosis. Histological analysis is unnecessary when radiographic features are present, but provides a useful diagnostic step in long bones in advanced cases of PBD. Limitations The radiographic sample in this study was limited to three individuals. Suggestions for further research The conclusion that radiography alone can be used to identify PDB in archaeological cases merits further research on a larger number of cases.