E051 Diagnosis and monitoring of Paget’s disease of bone: an audit across hospital departments in secondary care

Background/Aims Paget’s disease of bone is a chronic metabolic bone disease that predominantly affects older adults and is linked to bone pain and pathological fracture. A clinical guideline prepared on behalf of the Paget’s Association, the European Calcified Tissue Society and the International Osteoporosis Foundation was published on February 25th 2019. Here, we present an audit, reporting performance against these guidelines for all University Hospital Southampton departments, including rheumatology and medicine for the elderly. Methods All patients with a diagnosis of Paget’s disease of bone treated at University Hospital Southampton from 25th February 2019 to 2025 were identified from electronic patient records, where Paget’s disease had been included in diagnostic coding. Relevant information was extracted from electronic clinical records. Management was audited across a wide variety of domains, including documentation of alkaline phosphatase (ALP), X-rays, isotope bone scanning and treatment. Results A total of 143 patient records were audited. The mean age of patients was 86 years; no patient was under 50 years, and 60.8% were male. Pain was the presenting symptom in 27.3% cases, but in 25.2% of cases, Paget’s disease was an incidental radiological finding. The most common site affected was the pelvis (95 cases, 66.4 %), followed by the femur and lumbar spine. Targeted X-rays or CT scans were available to establish the extent of disease in almost all cases (127/143, 88.8 %), with only 1 patient not having a radiograph; we were unable to retrieve all imaging for the other 18 patients (12.6%). A radionuclide bone scan was performed in 38.4% cases, with much higher rates in those seen in rheumatology than in other departments only (68.3% vs 22.6%). Of patients diagnosed after the release of the new guidelines (n = 30), only those seen by rheumatology (n = 6) were more likely to have a bone scan performed (60% before vs 83% after). ALP levels were available in all rheumatology patients, and 88.7% patients were seen in other departments. Zoledronate was the most commonly prescribed bisphosphonate; 36.1% of patients had bisphosphonates prescribed, with much higher rates of prescription in rheumatology than other departments (73.3% vs 9.4%). In the majority of cases (65.4%), bisphosphonates were prescribed to alleviate symptoms rather than for ALP reduction. Conclusion Our results highlight missed opportunities in the investigation and management of Paget’s disease of bone in older adults, especially outside of hospital rheumatology departments. Targeted education to all specialties that may manage these patients, with dissemination of guidelines and re-audit, would be valuable. Disclosure P. Vahisan: None. E. Dennison: None. J. Zhang: None.