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Increased circulating Dickkopf-1 in Paget's disease of boneThis article discusses Dickkopf-1 (Dkk-1), which is a secreted inhibitor of Wnt signaling which in adults regulates bone turnover. Dkk-1 over-production is implicated in osteolytic disease where it inhibits bone formation and stimulates bone breakdown. Recently it was reported that osteoblastic cells from Paget's disease of bone (PDB) over-expressed Dkk-1. This study aimed yo see if increased Dkk-1 was detected in serum from patients with PDB. The results showed that Dkk-1 and total serum alkaline phosphatase activity (tsAP) were significantly elevated in sera from PDB patients. Patients with polyostotic PDB had significantly higher levels of tsAP but not Dkk-1, than monostotic patients. TsAP but not Dkk-1, was significantly lower in sera from bisphosphonate treated versus untreated PDB patients. Dkk-1 and tsAP were not significantly correlated. Dkk-1 may be a useful biomarker of PDB and the authors speculate that Dkk-1 may play a central role in the etiology of PDB.