Continuous decline in Paget’s disease of bone: a one health perspective on 2,342 new diagnoses and their association with rural livestock

Abstract Objectives To characterize the incidence of clinically diagnosed Paget’s disease of bone (PDB) in Castille and Leon, a region in the central plateau of Spain, from 2009 to 2019, and explores its association with environmental factors, particularly livestock activity. Methods We analysed primary care electronic medical records to assess PDB incidence trends over time and geographic differences across counties. An ecological study was conducted to explore associations between livestock density and PDB incidence in different regions. Results A total of 2342 new cases of PDB were identified, comprising 1362 males and 980 females, with a mean age of 77 years. The incidence demonstrated a declining trend in both genders. Higher incidence rates were observed in rural areas. A moderately positive correlation (R2 = 0.236) was identified between PDB incidence and the density of female breeding cattle. Regions with high densities of cattle exhibited an elevated prevalence of PDB. No significant correlations were found with other types of livestock. Conclusion Our findings corroborate the ongoing reduction in the prevalence of PDB. This decline cannot be attributed solely to genetic factors and is likely a consequence of shifts in environmental influences. The changing dynamics between humans and livestock, particularly in regions with significant livestock presence, emerge as a potential contributing factor. This hypothesis is consistent with the One Health concept, which highlights the interconnectedness of human, animal and environmental health.