The University of Southampton
University of Southampton Institutional Repository

Paget's disease of bone in The Netherlands: a population-based radiological and biochemical survey--the Rotterdam Study

Eekhoff, Marelise E.M.W., Van der Klift, Marjolein, Kroon, Herman M., Cooper, Cyrus, Hofman, Albert, Pols, Huibert A.P. and Papapoulos, Socrates E. (2004) Paget's disease of bone in The Netherlands: a population-based radiological and biochemical survey--the Rotterdam Study Journal of Bone and Mineral Research, 19, (4), pp. 566-570. (doi:10.1359/JBMR.040130).

Record type: Article


Serum ALP may be a good indicator of Paget's disease in epidemiologic studies. Subjects with raised and normal ALP from a population cohort were matched (1 in 6, total 548), and radiographs were taken. ALP was an excellent marker of the disease (RR, 10.9), but the majority of those affected had normal ALP.
Introduction: Evidence from radiographic surveys of limited skeletal sites has shown that Paget's disease of bone (PDB) is common in the elderly and has a distinct geographic variation. There is no information, however, about the relation of serum alkaline phosphatase (ALP) activity, a marker of the disease, and its prevalence in the population.
Materials and Methods: We analyzed data from a well-defined Dutch population cohort (the Rotterdam study) with the following specific aims: (1) to assess the relationship between serum ALP activity and prevalence of radiographically diagnosed PDB, (2) to estimate the overall prevalence of the disease in the Netherlands, and (3) to assess the appearance of the disease with time. Using a nested case-control design, subjects with an increased serum ALP and normal serum liver enzymes were matched for gender and age (1 to 6) with subjects with normal serum ALP activity. Radiographs of the thoracic and lumbar spine, pelvis, proximal femurs, knees, wrists, and hands were taken.
Results and Conclusions: PDB was diagnosed in 20.5% of subjects with elevated serum ALP activity and in 2.3% in those with normal serum ALP activity, increasing with age in both groups. The relative risk (RR) for PDB in the presence of raised serum ALP activity was 10.9 (95% CI, 4.8, 24.9). The estimated prevalence of PDB in the population was 3.6%, and the large majority (about 86%) had normal serum ALP activity, contrasting findings in bone clinics where the opposite is the case. Finally, in subjects with normal and raised serum ALP activity but no PDB at baseline, radiographs taken 6-9 years later showed no evidence of the disease. This study demonstrated that serum ALP activity is a sensitive marker of PDB in men and women >55 years of age, but the majority of those affected have normal serum ALP activity.

Full text not available from this repository.

More information

Published date: 2004


Local EPrints ID: 25442
ISSN: 0884-0431
PURE UUID: 36a0694c-8fa5-44e1-b187-6c2f0ef83416
ORCID for Cyrus Cooper: ORCID iD

Catalogue record

Date deposited: 12 Apr 2006
Last modified: 17 Jul 2017 16:10

Export record



Author: Marelise E.M.W. Eekhoff
Author: Marjolein Van der Klift
Author: Herman M. Kroon
Author: Cyrus Cooper ORCID iD
Author: Albert Hofman
Author: Huibert A.P. Pols
Author: Socrates E. Papapoulos

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton:

ePrints Soton supports OAI 2.0 with a base URL of

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.