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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Paget's disease of the mandible</title><author><name sortKey="Karunakaran, K" sort="Karunakaran, K" uniqKey="Karunakaran K" first="K" last="Karunakaran">K. Karunakaran</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Murugesan, P" sort="Murugesan, P" uniqKey="Murugesan P" first="P" last="Murugesan">P. Murugesan</name><affiliation><nlm:aff id="aff2"><italic>Department of Bio-Chemistry, J. K. K. Nataraja Dental College and Hospital, Komarapalayam, Namakkal, Tamil Nadu, India</italic></nlm:aff></affiliation></author><author><name sortKey="Rajeshwar, G" sort="Rajeshwar, G" uniqKey="Rajeshwar G" first="G" last="Rajeshwar">G. Rajeshwar</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Babu, Sharlenesara" sort="Babu, Sharlenesara" uniqKey="Babu S" first="Sharlenesara" last="Babu">Sharlenesara Babu</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22434946</idno><idno type="pmc">3303501</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303501</idno><idno type="RBID">PMC:3303501</idno><idno type="doi">10.4103/0973-029X.92984</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">001E87</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001E87</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Paget's disease of the mandible</title><author><name sortKey="Karunakaran, K" sort="Karunakaran, K" uniqKey="Karunakaran K" first="K" last="Karunakaran">K. Karunakaran</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Murugesan, P" sort="Murugesan, P" uniqKey="Murugesan P" first="P" last="Murugesan">P. Murugesan</name><affiliation><nlm:aff id="aff2"><italic>Department of Bio-Chemistry, J. K. K. Nataraja Dental College and Hospital, Komarapalayam, Namakkal, Tamil Nadu, India</italic></nlm:aff></affiliation></author><author><name sortKey="Rajeshwar, G" sort="Rajeshwar, G" uniqKey="Rajeshwar G" first="G" last="Rajeshwar">G. Rajeshwar</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Babu, Sharlenesara" sort="Babu, Sharlenesara" uniqKey="Babu S" first="Sharlenesara" last="Babu">Sharlenesara Babu</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Oral and Maxillofacial Pathology : JOMFP</title><idno type="ISSN">0973-029X</idno><idno type="eISSN">1998-393X</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Paget's disease (PD) is a chronic progressive disease of the bone characterized by abnormal bone resorption and deposition affecting either single bone (monostotic) or many bones (polyostotic) with uncertain etiology. We report a case of isolated mandibular involvement in a 65-year-old female patient, clinically asymptomatic with abnormally increased alkaline phosphatase level (1 368.1 U/l). Although prevalence of PD is common in western countries, but rare in Asian chapter, that too isolated mandibular involvement, considering this fact, we report this case of PD for documentation.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Wang, Wc" uniqKey="Wang W">WC Wang</name></author><author><name sortKey="Cheng, Ys" uniqKey="Cheng Y">YS Cheng</name></author><author><name sortKey="Chen, Ch" uniqKey="Chen C">CH Chen</name></author><author><name sortKey="Lin, Yj" uniqKey="Lin Y">YJ Lin</name></author><author><name sortKey="Chen, Yk" uniqKey="Chen Y">YK Chen</name></author><author><name sortKey="Lin, Lm" uniqKey="Lin L">LM Lin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kanis, Ja" uniqKey="Kanis J">JA Kanis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fredrick, R" uniqKey="Fredrick R">R Fredrick</name></author><author><name sortKey="Singer, Ch" 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Will</name></author><author><name sortKey="Criddle, Ra" uniqKey="Criddle R">RA Criddle</name></author><author><name sortKey="Prince, Rl" uniqKey="Prince R">RL Prince</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shawaff, Authmanand" uniqKey="Shawaff A">Authmanand Shawaff</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Joshi, Sr" uniqKey="Joshi S">SR Joshi</name></author><author><name sortKey="Ambhore, S" uniqKey="Ambhore S">S Ambhore</name></author><author><name sortKey="Butala, N" uniqKey="Butala N">N Butala</name></author><author><name sortKey="Patwardhan, M" uniqKey="Patwardhan M">M Patwardhan</name></author><author><name sortKey="Kulkarni, M" uniqKey="Kulkarni M">M Kulkarni</name></author><author><name sortKey="Pai, B" uniqKey="Pai B">B Pai</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Basle, Mf" uniqKey="Basle M">MF Baslé</name></author><author><name sortKey="Fournier, Jg" uniqKey="Fournier J">JG Fournier</name></author><author><name sortKey="Rozenblatt, S" uniqKey="Rozenblatt S">S Rozenblatt</name></author><author><name sortKey="Rebel, A" uniqKey="Rebel A">A Rebel</name></author><author><name sortKey="Bouteille, M" uniqKey="Bouteille M">M Bouteille</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mills, Bg" uniqKey="Mills B">BG Mills</name></author><author><name sortKey="Singer, Fr" uniqKey="Singer F">FR Singer</name></author><author><name sortKey="Weiner, Lp" uniqKey="Weiner L">LP Weiner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Reddy, Sv" uniqKey="Reddy S">SV Reddy</name></author><author><name sortKey="Singer, Fr" uniqKey="Singer F">FR Singer</name></author><author><name sortKey="Rodoman, Gd" uniqKey="Rodoman G">GD Rodoman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gordon, Mt" uniqKey="Gordon M">MT Gordon</name></author><author><name sortKey="Anderson, Dc" uniqKey="Anderson D">DC Anderson</name></author><author><name sortKey="Sharpe, Pt" uniqKey="Sharpe P">PT Sharpe</name></author><author><name sortKey="Mee, P" uniqKey="Mee P">P Mee</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Darroszewaka, A" uniqKey="Darroszewaka A">A Darroszewaka</name></author><author><name sortKey="Stuart, H" uniqKey="Stuart H">H Stuart</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Siris, Es" uniqKey="Siris E">ES Siris</name></author><author><name sortKey="Rodoman, Gd" uniqKey="Rodoman G">GD Rodoman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cahn, L" uniqKey="Cahn L">L Cahn</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jaffe, Hl" uniqKey="Jaffe H">HL Jaffe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Anjali" uniqKey="Anjali">Anjali</name></author><author><name sortKey="Thomas, N" uniqKey="Thomas N">N Thomas</name></author><author><name sortKey="Rajaratnam, S" uniqKey="Rajaratnam S">S Rajaratnam</name></author><author><name sortKey="Shanthly, N" uniqKey="Shanthly N">N Shanthly</name></author><author><name sortKey="Oommen, R" uniqKey="Oommen R">R Oommen</name></author><author><name sortKey="Seshadri, Ms" uniqKey="Seshadri M">MS Seshadri</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Joshi, Sr" uniqKey="Joshi S">SR Joshi</name></author><author><name sortKey="Ambhore, S" uniqKey="Ambhore S">S Ambhore</name></author><author><name sortKey="Butala, N" uniqKey="Butala N">N Butala</name></author><author><name sortKey="Patwardhan, M" uniqKey="Patwardhan M">M Patwardhan</name></author><author><name sortKey="Kulkarni, M" uniqKey="Kulkarni M">M Kulkarni</name></author><author><name sortKey="Pai, B" uniqKey="Pai B">B Pai</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Oral Maxillofac Pathol</journal-id><journal-id journal-id-type="publisher-id">JOMFP</journal-id><journal-title-group><journal-title>Journal of Oral and Maxillofacial Pathology : JOMFP</journal-title></journal-title-group><issn pub-type="ppub">0973-029X</issn><issn pub-type="epub">1998-393X</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22434946</article-id><article-id pub-id-type="pmc">3303501</article-id><article-id pub-id-type="publisher-id">JOMFP-16-107</article-id><article-id pub-id-type="doi">10.4103/0973-029X.92984</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Paget's disease of the mandible</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Karunakaran</surname><given-names>K</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Murugesan</surname><given-names>P</given-names></name><xref ref-type="aff" rid="aff2">1</xref></contrib><contrib contrib-type="author"><name><surname>Rajeshwar</surname><given-names>G</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Babu</surname><given-names>Sharlenesara</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib></contrib-group><aff id="aff1"><italic>Department of Oral Pathology, J. K. K. Nataraja Dental College and Hospital, Komarapalayam, Namakkal, Tamil Nadu, India</italic></aff><aff id="aff2"><label>1</label><italic>Department of Bio-Chemistry, J. K. K. Nataraja Dental College and Hospital, Komarapalayam, Namakkal, Tamil Nadu, India</italic></aff><author-notes><corresp id="cor1"><bold>Address for correspondence:</bold><italic> Dr. Karunakaran K, Department of Oral Pathology and Microbiology, J.K.K. Nataraja Dental College and Hospital, Komarapalayam - 638 183, Namakkal, Tamil Nadu, India. E-mail: <email xlink:href="anishdental@yahoo.co.in">anishdental@yahoo.co.in</email></italic></corresp></author-notes><pub-date pub-type="ppub"><season>Jan-Apr</season><year>2012</year></pub-date><volume>16</volume><issue>1</issue><fpage>107</fpage><lpage>109</lpage><permissions><copyright-statement>Copyright: © Journal of Oral and Maxillofacial Pathology</copyright-statement><copyright-year>2012</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Paget's disease (PD) is a chronic progressive disease of the bone characterized by abnormal bone resorption and deposition affecting either single bone (monostotic) or many bones (polyostotic) with uncertain etiology. We report a case of isolated mandibular involvement in a 65-year-old female patient, clinically asymptomatic with abnormally increased alkaline phosphatase level (1 368.1 U/l). Although prevalence of PD is common in western countries, but rare in Asian chapter, that too isolated mandibular involvement, considering this fact, we report this case of PD for documentation.</p></abstract><kwd-group><kwd>Bone disease</kwd><kwd>bone turnover</kwd><kwd>mandible</kwd><kwd>osteitis deformans</kwd><kwd>Paget's disease</kwd></kwd-group></article-meta></front><body><sec id="sec1-1"><title>INTRODUCTION</title><p>Paget's disease (PD) of bone was first described by Sir James Paget under as the term “osteitis deformans” in 1877.[<xref ref-type="bibr" rid="ref1">1</xref>] It is a chronic progressive disease involving single bone (monostotic) or many bones (polyostotic) of the body, characterized by rapid bone resorption and deposition, resulting in numerous reversal line formation which gives the mosaic pattern to the lamellar bone with profuse local vascularity and fibrous tissue in the marrow.[<xref ref-type="bibr" rid="ref2">2</xref>] Clinical symptoms include pain, deformity, and may lead to fracture of the affected bone, even though the initial course of the disease may be asymptomatic. The enlarged and deformed bones may compress surrounding nerves and vessels causing neurological symptoms like hearing loss; inexplicably, it is quite unusual in the facial bones. Facial disfigurement may be consequence of enlargement of the maxilla and/or mandible.[<xref ref-type="bibr" rid="ref3">3</xref>] Radiograph shows characteristic cotton wool appearance and other radiographic finding include well-circumscribed radiolucency, loss of lamina dura, pulpal radio-opacity, root resorption, and hypercementosis.[<xref ref-type="bibr" rid="ref4">4</xref>–<xref ref-type="bibr" rid="ref6">6</xref>] The etiology of PD is still obscure, but genetic and environmental factors may play a role. Viruses such as paramyxovirus, canine distember virus, and respiratory syncytial virus are also reported to be the causative agents.[<xref ref-type="bibr" rid="ref1">1</xref><xref ref-type="bibr" rid="ref3">3</xref>]</p><p>Therapeutic agents commonly used include calcitonin, bisphosphonate, and mithramycin.[<xref ref-type="bibr" rid="ref5">5</xref>] A recent clinical trial suggested that second and third generation bisphosphonate, such as pamidronate and alendronate, were more effective than calcitonin and editronate, the first generation bisphosphonate.[<xref ref-type="bibr" rid="ref7">7</xref>] Here, we are reporting a very rare case of PD with isolated mandibular involvement.[<xref ref-type="bibr" rid="ref8">8</xref>]</p></sec><sec id="sec1-2"><title>CASE REPORT</title><p>A 67-year-old female patient reported to a private dental clinic in Coimbatore, complaining of swelling in the lower jaw for past few years. History reveals a slow-progressive swelling with no other associated symptoms like pain, discharge, and non-responsive to any medication. Extra oral examination reveals broadening and widening of the lower facial view with thickened lower lip. Intra oral examination showed increased size and altered shape of the mandibular alveolar ridge, pseudo micrognathia of the maxillary arch [Figures <xref ref-type="fig" rid="F1">1</xref> and <xref ref-type="fig" rid="F2">2</xref>], and partially edentulous, thickened cortical plate. Orthopantomograph shows hypercementosis with displacement of involved teeth, cortical thickening of the body of the mandible, and mixed radiolucent and radio opaque areas [<xref ref-type="fig" rid="F3">Figure 3</xref>] on both sides of the mandible. Whole-body X-rays and scans were taken to ascertain the involvement of other bones [<xref ref-type="fig" rid="F4">Figure 4</xref>], confirming that the lesion was restricted to mandible only.</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>Extra oral view shows large mandible</p></caption><graphic xlink:href="JOMFP-16-107-g001"></graphic></fig><fig id="F2" position="float"><label>Figure 2</label><caption><p>Large size partially edentulous mandible</p></caption><graphic xlink:href="JOMFP-16-107-g002"></graphic></fig><fig id="F3" position="float"><label>Figure 3</label><caption><p>OPG shows hypercementosis of the teeth roots.</p></caption><graphic xlink:href="JOMFP-16-107-g003"></graphic></fig><fig id="F4" position="float"><label>Figure 4</label><caption><p>3D scan shows thickened mandibular cortical plate</p></caption><graphic xlink:href="JOMFP-16-107-g004"></graphic></fig><p>Incisional biopsy was taken, histopathology of lesion showed increased osteoblastic activity and irregular cortical bones with presence of hematoxyphilic reversal line giving the characteristic mosaic pattern. Marrow spaces were filled with fibro vascular connective tissue, confirming osteitis deformans [<xref ref-type="fig" rid="F5">Figure 5</xref>]. Biochemical analysis showed abnormal increase of alkaline phosphatase (ALP) enzyme level (1368.1 U/l) [<xref ref-type="fig" rid="F6">Figure 6</xref>] while comparing with the normal values of 30-120 U/l (above 17 years) and 74-390 U/l (below 17 years). Serum calcium and phosphorus levels were within the normal limits. Based on the clinical, radiographic, histopathological, and biochemical findings, a diagnosis of mandibular PD was rendered and was explained to the patient.</p><fig id="F5" position="float"><label>Figure 5</label><caption><p>(a) Irregular reversal line, (b) mosaic bone pattern histologically</p></caption><graphic xlink:href="JOMFP-16-107-g005"></graphic></fig><fig id="F6" position="float"><label>Figure 6</label><caption><p>Biochemical report</p></caption><graphic xlink:href="JOMFP-16-107-g006"></graphic></fig></sec><sec id="sec1-3"><title>DISCUSSION</title><p>Although PD is a relatively common disease in western countries like England, United States, New Zealand, Canada, South Africa, and France,[<xref ref-type="bibr" rid="ref1">1</xref><xref ref-type="bibr" rid="ref3">3</xref>] incidence in Asian population that too among Indians are very rare. Britain has the highest recorded prevalence. Within Britain and America, it is not uniformly distributed among all the states. There is localized area of high prevalence in Lancashire and Yorkshire in North America. Prevalence is markedly higher in New York than in Atlanta, although the disease rare in Africa. Incidence among American blacks and whites are equal.</p><p>PD is a geriatric disease reported above 5<sup>th</sup> to 6<sup>th</sup> decades of life, occurs both in men and women, with male predominance of approximately 3:2 ratio.[<xref ref-type="bibr" rid="ref9">9</xref>] Shashank <italic>et al</italic>. have described juvenile form of PD different from the adult form. Etiology of PD is unknown, but there is a hypothesis that vitamin D deficiency in children may express later as PD. Wide variations in PD prevalence are not understood. Studies have suggested an association with viral infection.[<xref ref-type="bibr" rid="ref10">10</xref>] Inclusion bodies resembling paramyxovirus nucleocapsid particles have been observed in pagetic osteoclasts by electron microscopy[<xref ref-type="bibr" rid="ref11">11</xref><xref ref-type="bibr" rid="ref12">12</xref>] and canine distemper virus has been localized by <italic>in-situ</italic> hybridization in the bone cells of patients with disorder.[<xref ref-type="bibr" rid="ref13">13</xref>] There is familial tendency of occurrence of PD and it is associated with polymorphisms in DNA coding in centrosome structure. Genetics could therefore also play a major role in determining prevalence of PD.[<xref ref-type="bibr" rid="ref14">14</xref>] But, it is evident from the decline in disease prevalence in Britain that undifferentiated environmental factors is also a major contributor.[<xref ref-type="bibr" rid="ref15">15</xref>]</p><p>The diagnosis of PD of the jaw is generally made only on clinical grounds. The specimen is received commonly after prosthetic repair. Isolated involvement of one or both the jaws, the clinical and radiographic appearances may be interpreted as those of chronic sclerosing osteomyelitis in such condition, histological examination of bone or teeth may be suggestive if not conclusive performance of biochemical test and adequate follow-up of the patient. If the disease affects isolated areas of bone such as maxilla or mandible, the biochemical values will be within the normal limits, whereas our case shows an increase of ALP level to many folds (1368.1 U/l) despite isolate involvement of mandible.[<xref ref-type="bibr" rid="ref16">16</xref>]</p><p>As the stresses of mastication causes very active turnover of bone, the jaw bones contain numerous irregular reversal lines than does bone from other parts.[<xref ref-type="bibr" rid="ref17">17</xref>] Healing infectious periostitis with excessive bone formation as a possible cause of numerous cement lines produces chaotic (mosaic) bone architecture. But, when mosaics appear in conditions other than PD, their extent is limited and more regular, this fact coincide with our case, irregular mosaic pattern with numerous reversal line in our histopathological study.</p><p>Since the major defect in PD is exaggerated bone remodeling, treatment is based on powerful antiresorptive agent. Bisphosphonates form the main stay of medical management of PD. These agents suppress or reduce bone resorption by osteoclasts. Five bisphosphonates are approved by the US food and drug administration for the treatment of PD. These include pamidronate, which is given intravenously, etidronate, tiludronate, alendronate, and risedronate, all of which are taken orally. The case series from Vellore and Mumbai suggests that lower doses of alendronate might work well in Indian patients.[<xref ref-type="bibr" rid="ref18">18</xref><xref ref-type="bibr" rid="ref19">19</xref>] Calcitonin therapy is conventional but now infrequently used therapy. Pain management and surgery are also used when indicated.</p></sec><sec id="sec1-4"><title>CONCLUSION</title><p>We report a rare case of isolated mandibular PD in a 65-year-old Indian female patient with abnormal increase of ALP level (1368.1 U/l) considered to be unique in our case.</p></sec></body><back><fn-group><fn fn-type="supported-by"><p><bold>Source of Support:</bold> Nil.</p></fn><fn fn-type="conflict"><p><bold>Conflict of Interest:</bold> None declared.</p></fn></fn-group><ref-list><title>REFERENCES</title><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>WC</given-names></name><name><surname>Cheng</surname><given-names>YS</given-names></name><name><surname>Chen</surname><given-names>CH</given-names></name><name><surname>Lin</surname><given-names>YJ</given-names></name><name><surname>Chen</surname><given-names>YK</given-names></name><name><surname>Lin</surname><given-names>LM</given-names></name></person-group><article-title>Paget's disease of bone in a Chinese patient: A case report and review of the literature</article-title><source>Oral Surg Oral Med Oral Pathol Oral Radiol Endod</source><year>2005</year><volume>99</volume><fpage>727</fpage><lpage>33</lpage><pub-id pub-id-type="pmid">15897860</pub-id></element-citation></ref><ref id="ref2"><label>2</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Kanis</surname><given-names>JA</given-names></name></person-group><source>Editor Pathophysiology and treatment of Paget's diseases of bone</source><year>1998</year><edition>2nd ed</edition><publisher-loc>London</publisher-loc><publisher-name>Martin Dunitz</publisher-name></element-citation></ref><ref id="ref3"><label>3</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Fredrick</surname><given-names>R</given-names></name><name><surname>Singer</surname><given-names>CH</given-names></name></person-group><article-title>Paget's disease of bone</article-title><source>Bone program</source><year>2008</year><publisher-loc>Santa Monica, California</publisher-loc><publisher-name>A Publication of the Paget Foundation for Paget's Disease of Bone and Related Disorders</publisher-name></element-citation></ref><ref id="ref4"><label>4</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Neville</surname><given-names>BW</given-names></name><name><surname>Damm</surname><given-names>DD</given-names></name><name><surname>Allen</surname><given-names>CM</given-names></name><name><surname>Bouquot</surname><given-names>JE</given-names></name></person-group><article-title>Paget's disease of bone. 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