P081 Paget’s disease: a single centre experience over 13 years

Abstract Background/Aims Paget’s disease is a chronic disorder characterized by focal abnormalities in bone remodelling. It is the second commonest bone condition after osteoporosis, with Caucasians aged >50 most affected. In 2019, Paget’s Association UK guidelines recommended total alkaline phosphatase (ALP) for baseline screening, radionuclide bone scans and targeted radiographs to define disease extent, and IV zoledronate as first-line treatment. We aimed to describe the clinical characteristics of the Paget’s cohort at the Royal United Hospital (RUH), Bath. Methods We performed a retrospective audit of our Paget’s registry from January 2011 to May 2024 through review of clinic letters, investigations, and imaging. Findings were tabulated and summarized using simple descriptive statistics. Results Our cohort comprised 31 Caucasians (54.8% female) with mean age at diagnosis 67.5 years. No patients reported a family history. Referrals were based on clinical symptoms in 13 patients (42%), while elevated ALP and abnormal imaging accounted for 9 referrals (29%) each. Patient characteristics are summarized in Table 1. Twenty-one patients (68%) had monostotic disease and the pelvis was the most frequent site. Radionuclide bone scans were done in 19 patients, of which 16 showed active disease (12 monostotic). Total ALP was elevated in 16 patients (51.6%) at baseline, and 24 patients (77.4%) at some point during their disease course. 25/31 patients (81%) were treated with IV zoledronate, typically a single infusion. Three patients required multiple infusions, ranging from 2 (n = 2) to 4 (n = 1) in total. Two patients with coexistent osteoporosis received denosumab; one patient did not require treatment due to inactive disease. Six patients developed osteoarthritis, of whom 3 required joint replacements (2 knees, 1 hip). Other complications included spinal stenosis from vertebral involvement and proptosis due to skull disease (n = 1 each). One patient with limb deformity underwent corrective surgery. No pathologic fractures or bone tumours were identified. Conclusion Our cohort showed a slight female predominance, with diagnoses peaking in the 7th decade. Monostotic involvement was common with the hemipelvis most affected. Most of our patients were treated with IV zoledronate as per the 2019 guideline. Secondary osteoarthritis was the most observed complication, with no pathologic fractures or bone tumours. Disclosure A. Akpabio: None. S. Hardcastle: None.