D., an endocrinologist at Columbia University College of Physicians and Surgeons in New York City. She says the risk increases if the first-degree relative has more severe disease and an early age at diagnosis. Paget's disease is rarely diagnosed in people under 40, although there have been cases. Siris says she's treated patients in their late 20s and 30s. The family history related by several patients seems to bear out Siris' conclusions: Evelyn Nef, 83, of Washington, D.C., who was diagnosed with Paget's disease in 1962, says her brother and sister also suffer from the disease. Halstead, who was diagnosed in his 30s, says his two brothers have the disease and his mother, who is 102, was diagnosed 3 years ago.
The role of genetics also is supported by observations that certain ethnic groups have higher rates of Paget's disease. According to the Paget Foundation, Paget's disease is most common in Caucasian people of Anglo-Saxon and European descent, but it also occurs in African Americans. It is rare in people of Asian descent (Kurtzweil). .
Research by Frederick Singer, M.D., an endocrinologist with the John Wayne Cancer Institute at Saint John's Hospital and Health Center, in Sante Monica, California, may eventually yield proof of a genetic role. Studying an Iowa with a history of Paget's disease, Singer and his colleagues traced a genetic abnormality to chromosome 18. The precise gene has yet to be identified, Singer says, but when it is, genetic tests may be able to predict who will get the disease. "I think its coming pretty fast,"" he says.
Many other experts suspect that a slow virus may play a role. The theory is that the virus infects a person early in life, without causing symptoms for many years. This theory is based on studies identifying viral-like particles in osteoclasts from pagetic bone. According to Sakamri Reddy, Ph.D., assistant professor at the University of Texas Health Science Center at San Antonio, these particles react with antibodies that detect a group of viruses, which includes the measles and canine distemper viruses.
