Paget disease of the bone (PDB), also known as osteitis deformans, is a disorder caused by accelerated bone remodeling resulting in bone overgrowth at single or multiple sites, and impaired integrity of the affected bone.1,2 PDB is often asymptomatic and diagnosed due to incidental findings of elevated serum alkaline phosphatase (ALP) or characteristic radiographic findings. Occasionally, the disease causes symptoms, and when it does, it usually manifests as pain that can derive from the pagetic lesion itself or from its complications.3 The complications of the disease depend on the affected site, and include hearing loss, headaches, nerve compression, bowing, arthritis, and bone neoplasms.4,5

Typically, PDB has been described in middle aged people in European countries and in countries with people who are mostly of European descent.6, 7, 8, 9 However, based on our clinical observation, we developed the hypothesis that in the Southeastern United States (US) the disease has a different racial distribution, with a higher proportion of African American patients diagnosed. The pathogenesis of the disease implicates genetic and environmental factors.10 Hence, this observation might suggest there is a cluster of people that have been exposed to an environmental trigger or that there is a genetic variant in individuals of African descent in the Southeastern US. In this study, we aim to determine if among people with PDB diagnosed in a Southeastern Veterans Affairs (VA) Medical Center the proportion of African American patients is higher than the proportion of White patients and if there are differences in the clinical characteristics and presentation of African American patients that might suggest a more severe phenotype.