Background/Purpose: Osteitis deformans, commonly referred to as Paget’s Disease of the Bone (PDB), affects adults over the age of 55, mainly of European descent and is characterized by accelerated turnover of bone with abnormalities to remodeling and overgrowth involving multiple regions of the body. Studies have shown a slight male predominance, although others have found equal distributions between genders. Most PDB cases are asymptomatic, however some may develop complications such as arthritis, fractures and diffuse pain. An observational, retrospective cohort study using the TriNetX database was conducted which uses electronic health records from over 140 global collaborative networks to explore both racial and gender differences between patients with PDB.

Methods: Patients 18 years and older were included using ICD-10 code M88 for the diagnosis of PDB. Two cohorts were studied: males and females above the age of 18. The index event was defined as the first appearance of the diagnosis of PDB. Propensity matching included age, race/ethnicity, hypertension, obesity, diabetes, tobacco use, acute myocardial infarction, cerebral infarction, hyperlipidemia and medications commonly used in the treatment of PDB. Outcomes evaluated included mortality, chronic pain syndrome, heart failure, hearing loss, osteosarcoma, osteoporosis, fractures, chronic kidney disease, anxiety, depression and OA. Those who experienced any of the above outcomes prior to the index event were excluded from the study and a risk/risk ratio calculation was measured.

Results: The dataset included 10,972 females and 11,904 males. After propensity matching a total of 4,862 people were excluded, which left 9,007 in each group. The average age after matching was 70.7 in the female group, and 71 in the male group respectively. Most patients were not Hispanic or Latino and were mostly White or of unknown ethnicity. Analysis of the outcomes showed a statistically significant difference in chronic pain (RR 1.18, 95% CI 1.09-1.278, P< 0.0001), osteoporosis (RR 2.44, 95% CI 2.188-2.721, P< 0.0001), anxiety (RR 1.62, 95% CI 1.464-1.794, P< 0.0001), depression (RR 1.49, 95% CI 1.336-1.671, P< 0.0001) and OA (RR 1.295, 95% CI 1.202-1.395, P< 0.0001) in females. Additionally, heart failure (RR 0.864, 95% CI 0.782-0.954, P 0.0038) and chronic kidney disease (RR 0.9, 95% CI 0.818-0.991, P 0.0315) were found to be statistically significant in males. There was no difference in the incidence of mortality, hearing loss, osteosarcoma or fractures between the two cohorts.

Conclusion: The findings demonstrated females with PDB are at a higher risk for chronic pain, osteoporosis, anxiety, depression and OA, whereas men are at higher risk for heart failure and chronic kidney disease. Most participants in this study were non-Hispanic and White, consistent with previous demographic data. However, there was also significant representation from Black/African American and Asian patients. This study signifies that racial and gender differences exist in patients with PDB and more research needs to be conducted to further explain these findings and to potentially identify any confounding or causative variables which may have influenced the observed findings.

Table 1: Baseline Characteristics of Both Cohorts Before (Left) and After (Right) Propensity Matching

Table 2: Differences in the Outcomes of Both Cohorts

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/analyzing-gender-and-racial-disparities-in-pagets-disease-of-bone-a-large-scale-observational-study/