Enthesopathy formation in the humerus: Data from known age‐at‐death and known occupation skeletal collections

Enthesopathies, in the guise of musculoskeletal skeletal stress markers (MSM), have been widely used to reconstruct activity levels in human skeletal populations. In general, studies have focused on their presence in the upper limb, which is used in the majority of daily activities. The aim of this study was to use some of the attachment sites on the humerus to explore the relationship between enthesopathy formation, activity, and the ageing process. The skeletal sample used in this study comprised male adult skeletons with known age‐at‐death and known occupations from the late‐19th and early‐20th century cemeteries in Portugal. The enthesopathies were recorded as either present or absent. Statistical analysis using Fishers exact tests and logistic regression was undertaken to determine whether associations could be found between specific activities or socioeconomic status (manual or nonmanual workers), and age and enthesopathy presence. Left and right sides were analyzed separately. Fisher's exact tests were used to determine the relationship between activity and enthesopathy, and they demonstrated no association between activity and enthesopathies (P > 0.01). The results of the logistic regression established that age was the single most significant factor in enthesopathy formation (P > 0.05). This study found that, in these samples, age‐at‐death, and therefore age‐related degeneration rather than degeneration caused by activities, was the primary cause of enthesopathy formation. Considering the difficulties of reliably ageing adult human skeletal remains, this is a major issue for studies of activity using enthesopathies. Am J Phys Anthropol, 2010. © 2009 Wiley‐Liss, Inc.     

Paleopathology of skeletal fluorosis

Skeletal fluorosis is one of a range of conditions causing excessive ossification and joint ankylosis in skeletons. It is rarely considered, however, in differential diagnoses of palaeopathological lesions. This paper considers the identification of skeletal fluorosis in a skeletal sample from the island of Bahrain, Arabian Gulf, dating to ca. 250 BC–AD 250. Approximately 4% of 255 adult skeletons in the sample have hyperostosic lesions resulting in joint ankylosis primarily of the lumbar vertebrae, as well as the major joints. These lesions most frequently occur among males in the 50+ age group. Chemical analysis on a small series of bone and dental samples confirmed the presence of high levels of fluoride, while staining of the teeth is evidence of dental fluorosis. The level of dental fluorosis is comparable with a naturally occurring fluoride level in water of between 1–2 ppm. The prevalence of hyperostosic lesions, however, appears higher than expected, and two possible reasons are suggested: confusion between a diagnosis of diffuse idiopathic skeletal hyperostosis and skeletal fluorosis on partial or less severely affected skeletons; and the presence of predisposing factors for skeletal fluorosis on the island in the past. Am J Phys Anthropol 109:465–483, 1999. © 1999 Wiley-Liss, Inc.     

Porotic hyperostosis: new evidence to support the anemia theory

The etiology of skull lesions known as porotic hyperostosis has long been a matter for speculation. The most widely accepted theory at present suggests that an anemia, either acquired or genetic, is responsible for lesion development. However, acceptance of this theory is not universal and the nature of the relationship between orbital and vault lesions remains a controversial issue. This paper provides a much broader field of supportive evidence on which to base the anemia theory. This involves a synthesis of information from the clinical and anthropological literature as well as new data from two skeletal collections: Poundbury Camp, a Romano-British series, and the Hodgson collection, a 19th century East Asian series. A comparison is made between clinical and anthropological data at the macroscopic, microscopic, radiographic, and demographic levels of analysis. This approach reveals the similarities in expression between clinically diagnosed anemias and porotic hyperostosis.     

Age and sex bias in the reconstruction of past population structures

Palaeodemographical studies are founded on the assumption that the sex and age distribution of the skeletal sample reflects the constitution of the original population. It is becoming increasingly clear, however, that the type and amount of information that may be derived from osteoarchaeological collections are related to the state of preservation of remains. This work proposes a new method to evaluate bone preservation, to identify age and sex biases in the preservation of human skeletal remains, and to assess whether differences in preservation patterns are more dependent on factors intrinsic or extrinsic to anatomical features of human bones. Three osteological collections and over 600 skeletons were observed. The state of preservation of human bones was assessed using three preservation indexes: the anatomical preservation index (API), the bone representation index (BRI), and the qualitative bone index (QBI). The results suggest that subadult skeletons are generally more poorly preserved and with bones less well-represented than adult skeletons. Among subadults, female and male skeletons have different patterns of preservation according to their age. This pattern of preservation depends on intrinsic anatomical properties of bones themselves, while external factors can only increase these differences in the state of preservation and representation of osseous remains. It is concluded from this that failure to recognize these differences may lead to misleading interpretations of paleodemography of past human populations.     

Anatomy of a serial killer: differential diagnosis of tuberculosis based on rib lesions of adult individuals from the Coimbra Identified Skeletal Collection, Portugal

The role of new bone formation on visceral surfaces of ribs in the diagnosis of tuberculosis (TB) in past human populations has been explored by many researchers, using both skeletal remains with known causes of death and archaeological samples. This study focuses, firstly, on adult skeletons from the Coimbra Identified Skeletal Collection in Portugal and investigates the skeletal manifestations of individuals known to have died from TB; secondly, this study focuses on the role of rib lesions in the diagnostic criteria for TB. One hundred and fifty-seven males and 106 females aged between 22-87 years were examined; causes of death were assigned as pulmonary TB, extrapulmonary TB, and pulmonary non-TB; a control group, extrapulmonary non-TB, was selected from the remaining individuals. Of individuals with rib lesions, 85.7% (69/81) had pulmonary or extrapulmonary TB as an assigned cause of death, while 17.8% (16/90) of individuals with rib lesions had a non-TB cause of death. Rib lesions were significantly more common in individuals who had died from TB, although the lesions cannot be considered pathognomonic for TB. In individuals dying from pulmonary TB, ribs in the central part of the rib cage were most affected, at their vertebral ends. The lower part of the rib cage may be a marker for peritoneal TB, and "coral-like" new bone formation on ribs may be an indicator of neoplastic disease. Further work on rib involvement in TB in clinical contexts, and the study of further documented skeletal collections, are recommended.     

On the trail of pulmonary tuberculosis based on rib lesions: results from the Human Identified Skeletal Collection from the Museu Bocage (Lisbon, Portugal)

In the last 20 years, studies on human identified skeletal collections have revealed a significant relationship between new bone formation on the visceral surface of ribs and pulmonary tuberculosis (TB). To improve methods of differential diagnosis of respiratory diseases in archaeological skeletons, an investigation was conducted on 197 individuals from the Human Identified Skeletal Collection of the Museu Bocage (Lisbon, Portugal). This sample included 109 males and 88 females who lived during the 19th-20th centuries, with ages at death ranging from 13-88 years. The skeletons were grouped according to cause of death: 1) pulmonary TB (N = 84); 2) pulmonary non-TB diseases (N = 49); and 3) a control group (N = 64) composed of individuals randomly selected among the extrapulmonary non-TB causes of death. The ribs, sterna, scapulae, and clavicles were macroscopically observed. New bone formation on the visceral surface of ribs was recorded in 90.5% (76/84) of individuals who died from pulmonary TB, in 36.7% (18/49) with a pulmonary non-TB disease as cause of death, and in 25.0% (16/64) of the control group. These differences were statistically significant (P < 0.001). Furthermore, in individuals with pulmonary TB, the bony lesions presented mainly as lamellar bone on the vertebral end of the upper and middle thoracic rib cage. Proliferative alterations also occurred on one sternum and in nine clavicles and eight scapulae. This work strongly supports the results of similar studies performed on other documented collections, suggesting that new bone formation on ribs, although not pathognomonic, is a useful criterion for the differential diagnosis of pulmonary TB.     

Comparison of radiologic and gross examination for detection of cancer in defleshed skeletons

The reliability of visual examination of defleshed bones was assessed for detection of postcranial metastatic disease in individuals known to have had cancer. This was compared with standard clinical radiologic techniques. The skeletons of 128 diagnosed cancer patients from an early 20th century autopsied skeletal collection (Hamann-Todd Collection) were examined. Radiologic examination detected evidence of metastatic disease in 33 individuals, compared to 11 by visual examination of the postcranial skeletons. Four of these cases were detected by both techniques. Blastic lesions were most commonly overlooked on visual examination, because they were localized to trabecular (internal bone) structures. The ilium was the most commonly affected bone, with lytic or blastic lesions detected in 30 of 33 individuals. While the proximal femur was affected in only nine individuals, x-ray of the proximal femur and ilium detected all individuals with postcranial evidence of metastatic disease. Skeletal distribution of metastases provides no clue to the location of origin or histologic subtype of the cancer. Survey of archeological human remains for metastatic cancer requires radiologic examination. Such skeletal surveys should x-ray at least the ilia and femora. © 1995 Wiley-Liss, Inc.     

Bone microstructure and its hidden information

Human bone micromorphology gives clues to a variety of life history parameters, such as individual age, health status, and physical activity. In the course of an ongoing study, thin cross sections of femoral compact bone from three skeletal series are investigated for different purposes. The first series consists of 103 adult skeletons excavated from a 19th century hospital graveyard in Basel, Switzerland. Several disease- and stress-markers, like layers of arrested growth or other conspicuous microstructural composition were observed. Another 36 individuals come from the dissection room of the Ludwig Maximilians University of Munich. These individuals have an average age at death of about 80 years and offer the possibility to investigate the micromorphological characteristics of individuals of very advanced age. Finally, 72 medieval subadult skeletons shall serve for the establishment of a relationship between individual age and bone microstructural parameters according to the different ontogenetic stages.     

Osteological and molecular identification of Brucellosis in ancient Butrint, Albania

Ancient skeletal remains can harbor unique information about past civilizations at both the morphological and molecular levels. For instance, a number of diseases manifest in bone, some of which have been confirmed through DNA analysis, verifying their presence in ancient populations. In this study, anthropological analysis of skeletal remains from the ancient Albanian city of Butrint identified individuals with severe circular lytic lesions on their thoracic and lumbar vertebrae. Differential diagnosis suggested that the lesions resulted from pathologies known to affect these skeletal regions, such as tuberculosis (TB) or brucellosis. Relevant bones of two adolescent males from the 10th to 13th century AD that displayed the lesions, along with unaffected individuals, were collected in the field. Genetic screening of the skeletal samples for TB was repeatedly negative, thus additional testing for Brucella spp.-bacteria of livestock and the causative agent of brucellosis in humans-was conducted. Two Brucella DNA markers, the IS6501 insertion element and Bcsp31 gene, amplified from the affected vertebrae and/or ribs, whereas all unaffected individuals and control samples were negative. Subsequent DNA sequencing confirmed the presence of the brucellar IS6501 insertion element. On the basis of the skeletal lesions, negative tests for TB, and positive Brucella findings, we report a confirmed occurrence of brucellosis in archaeologically recovered human bone. These findings suggest that brucellosis has been endemic to the area since at least the Middle Ages.     

Bone fractures as indicators of intentional violence in the eastern adriatic from the antique to the late medieval period (2nd-16th century AD)

To test the historically documented hypothesis of a general increase in deliberate violence in the eastern Adriatic from the antique (AN; 2nd–6th c.) through the early medieval (EM; 7th–11th c.) to the late‐medieval period (LM; 12th–16th c.), an analysis of the frequency and patterning of bone trauma was conducted in three skeletal series from these time periods. A total of 1,125 adult skeletons—346 from the AN, 313 from the EM, and 466 from the LM series—were analyzed. To differentiate between intentional violence and accidental injuries, data for trauma frequencies were collected for the complete skeleton, individual long bones, and the craniofacial region as well as by type of injury (perimortem vs. antemortem). The results of our analyses show a significant temporal increase in total fracture frequencies when calculated by skeleton as well as of individuals exhibiting one skeletal indicator of deliberate violence (sharp force lesions, craniofacial injuries, “parry” fractures, or perimortem trauma). No significant temporal increases were, however, noted in the frequencies of craniofacial trauma, “parry” fractures, perimortem injuries, or of individuals exhibiting multiple skeletal indicators of intentional violence. Cumulatively, these data suggest that the temporal increase in total fracture frequencies recorded in the eastern Adriatic was caused by a combination of factors that included not only an increase of intentional violence but also a significant change in lifestyle that accompanied the transition from a relatively affluent AN urban lifestyle to a more primitive rural medieval way of life. Am J Phys Anthropol 2012. © 2012 Wiley Periodicals, Inc.     

The effects of pathology on skeletal populations

The effects of pathology on skeletal populations are indirect as well as direct. A review of the histories of four collections in the National Museum shows that the indirect effects come about largely because collectors sometimes select the skeletons to be saved. If selection is on the basis of state of preservation, it can be against pathological specimens since lesions sometimes weaken the bones and hasten their deterioration. If selection is on the basis of interest in pathology, it can exaggerate the representation of diseased specimens in the collections. As civilization advanced and man learned how better to cope with diseases, life expectancy increased and with it the evidence in the bones of the scars of living. The effects of pathology on skeletal populations are thus proportional to the mean ages of the latter. Aside from gross osseous lesions, the direct effects of pathology on skeletal populations are difficult to demonstrate. In so far as changes in size are concerned the effects thus far detected seem to be more proportional than linear. As regards pathological states with hereditary bases, they will affect populations to the extent that involved family lines are represented.     

Skeletal manifestations of rickets in infants and young children in a historic population from England

Gross and radiographic changes characteristic of inadequate bone mineralization due to rickets are described in 21 immature skeletons from a 19th century urban population from Birmingham, England. The aims of the study are as follows: to evaluate and if possible augment existing dry-bone criteria for the recognition of rickets in immature skeletal remains; to investigate the value of radiography for the paleopathological diagnosis of rickets; and to compare and contrast the expression of rickets in this group with that previously documented for a rural agrarian population from Wharram Percy, England. Some gross skeletal signs of rickets which were not previously well-documented in paleopathological studies are noted. The worth of radiography for evaluating structural changes to both cortical and trabecular bone in the disease is demonstrated, and features useful for the interpretation of vitamin D deficiency are discussed. The pattern of skeletal elements affected and the severity of changes differs in the Birmingham group from that seen in the comparative rural population. It is emphasized that a variety of factors may influence the expression of rickets in paleopathological material, including rate of skeletal growth, age cohort affected, and intensity of vitamin D deficiency. Nevertheless, careful analysis, not only of the frequency of rickets but also of the degree of severity of lesions and the patterning with respect to skeletal elements affected, may enable more nuanced understanding of the biocultural context of the disease in earlier populations.     

Skeletal evidence of tuberculosis in a modern identified human skeletal collection (Certosa cemetery,Bologna, Italy)

The diagnosis of tuberculosis (TB) in osteoarcheological series relies on the identification of osseous lesions caused by the disease. The study of identified skeletal collections provides the opportunity to investigate the distribution of skeletal lesions in relation to this disease. The aim of this study was to examine the skeletal evidence for TB in late adolescent and adult individuals from the identified human collection of the Certosa cemetery of Bologna (Italy, 19th–20th c.). The sample group consists of 244 individuals (138 males, 106 females) ranging from 17 to 88 years of age. The sample was divided into three groups on the basis of the recorded cause of death: TB (N = 64), pulmonary non‐TB (N = 29), and other diseases (N = 151). Skeletal lesions reported to be related to TB were analyzed. The vertebral lesions were classified into three types: enlarged foramina (EnF, vascular foramina with diameter of 3–5 mm), erosions (ER), and other foramina (OtF, cavities of various shapes > 3 mm). A CT scan analysis was also performed on vertebral bodies. Some lesions were seldom present in our sample (e.g., tuberculous arthritis). OtF (23.7%) and subperiosteal new bone formation on ribs (54.2%) are significantly more frequent in the TB group with respect to the other groups. The CT scan analysis showed that the vertebrae of individuals who have died of TB may have internal cavities in the absence of external lesions. These traits represent useful elements in the paleopathological diagnosis of TB. Am J Phys Anthropol 157:389–401, 2015. © 2015 Wiley Periodicals, Inc.     

Evaluation of morphological sex determinations by molecular analyses

The study presents an evaluation of morphological sex determinations of adult skeletal individuals based on traits of the ossa coxae and the cranium. The evaluation criterion was genetic analysis of the amelogenine gene, which represents parts of the X- and the Y-chromosome (Mannucci et al. 1994). The study was carried out on 33 human skeletons from an early modern burial site in Lower Saxony. In this skeletal series, 88% of the morphological sex determinations matched the genetic sex. The percentage of matches was further improved, if only those morphological determinations were taken into account that were classified as unambiguous by a self-evaluation. In the reverse case, a significant number of non-matching determinations (33%) resulted from those cases in which a sex determination still seemed possible but was classified as "ambiguous" in the self-evaluation. At least within this skeletal series, no clear connection could be detected between the number of matching results and the presence or absence of the ossa coxae. This might be due to a strong cranial dimorphism within this particular skeletal series.     

Life stress on the Roman limes in continental Croatia

The purpose of the paper is to analyze and compare the demographic profiles and disease frequencies between a skeletal series from Zmajevac, a settlement on the Danubian limes, and a composite «non-limes» skeletal series consisting of human osteological remains from three large urban settlements to the west of the limes; roman Mursa (modern Osijek), Cibalae (Vinkovci) and Certissia (Štrbinci). To determine if life stresses were different in settlements on the limes the age and sex distribution in Zmajevac was compared to the composite «non-limes» series. All skeletons were also analyzed for the presence of dental pathology, dental enamel hypoplasia, cribra orbitalia, trauma, and physical stress.

Data collected from the skeletal series show that, with the exception of some indicators of physical stress, no significant differences in quality of life is evident. Both series are characterized by an underrepresentation of subadults from the youngest age category and by similar average adult male and female ages at death. In Zmajevac the average ages at death for adult males and females were 40.0 and 39.0 years respectively, in the composite «non-limes» series 37.4 years for both males and females. The frequencies of dental disease, subadult stress indicators, and trauma are similar in both series. The only consistent difference between the two series is noted in the frequencies of skeletal markers of physical stress, in particular the frequencies of vertebral osteoarthritis and Schmorl's defects. Total male and total female vertebral osteoarthritis frequencies in the two series are significantly different, as is the difference in total male frequencies of Schmorl's defects. Young adult males in the Zmajevac series seem to have been experiencing particularly heavy physical strain on the vertebral column. They exhibit significantly higher frequencies of both vertebral osteoarthritis and Schmorl's defects than young adult males from the composite non-limes series.     

Brief communication: co-detection of Bartonella quintana and Yersinia pestis in an 11th-15th burial site in Bondy, France

Historical and anthropological data suggest that skeletons excavated from an 11th to 15th century mass grave in Bondy, France, may be those of victims of the Great Plague. Using high-throughput real-time PCR investigation of the dental pulp collected from 14 teeth from five such skeletons, we detected Bartonella quintana DNA in three individuals and Yersinia pestis DNA in two individuals. DNA from five other deadly pathogens was not found. Suicide PCR genotyping confirmed Y. pestis DNA belonging to the Orientalis biotype. One individual had co-infection. These data suggest a plague epidemic in a population already infected by the body louse-transmitted B. quintana or a body louse-driven transmission of the plague that drove a medieval epidemic in inland Europe.     

Dental health and lifestyle in four early mediaeval juvenile populations: Comparisons between urban and rural individuals, and between coastal and inland settlements

Dental stress markers such as enamel hypoplasia and caries are suitable indicators of population health and lifestyle, although they must be recorded and interpreted carefully. To date, they have been predominantly studied in adult samples, whereas juvenile remains are also affected by these lesions. In this study, dental enamel hypoplasia and caries were both evaluated on 613 non-adult individuals from four early mediaeval Moravian and Frankish skeletal series, who had experienced contrasting environments and lifestyles. The aim of this study is to assess the relationship between these biological traits and living conditions, and how this is manifested in the juvenile dental remains.Significant differences between populations were found in stress markers, dental lesions and the way these were manifested. Exposure to stressful conditions varies between urban and rural populations and is related to age groups. Although the children under investigation seem to have had different diets, it is difficult to distinguish the biological contribution (different enamel susceptibility) from the lifestyle contribution (different food, environment) in the formation of caries. Moreover, such studies must be interpreted carefully due to the possibility of intra- and inter-observer errors and the subjectivity of the scoring techniques.Nevertheless, this study also demonstrates that results of an investigation of juvenile skeletal remains can be as informative as a study of adults and that juvenile skeletons can be included in large bioarchaeological population studies.     

Rib lesions in chronic pulmonary tuberculosis

The diagnosis of skeletal tuberculosis in human remains has traditionally been based upon the detection of secondary skeletal lesions which result from hemotogenous dissemination of tubercle bacilli (e.g., Pott's disease). Since such lesions develop in less than 7% of cases of human tuberculosis, the paleodemography and paleoepidemiology of this disease have been difficult to assess from skeletal remains. This study presents a new diagnostic approach to tuberculosis, focusing on the skeletal manifestations of chronic pulmonary disease (which comprises approximately 90% of human-form tuberculosis). Four hundred forty-five skeletal remains from persons dying of tuberculosis during the first half of the 20th century were examined. A total of 70/445 (16%) exhibited skeletal lesions in one or more locations as a response to infection. Of these 70, 39 (56%) were found to display a specific set of lesions restricted to the internal aspect of the ribs. These lesions take one of two forms: (1) diffuse periostitis or (2) localized abscess, and appear to correspond to areas of chronic pulmonary infection. The diffuse type of rib lesion is more commonly observed than the localized type. In our observations (and according to the natural history of tuberculosis) the occurrence of chronic pulmonary tuberculosis is usually mutually exclusive with hematogenous dissemination to secondary bone locations. Thus, the detection of rib lesions in cases of chronic pulmonary disease increases the absolute sample size of skeletal tuberculosis by a factor of two in this study.     

Brief communication: The Granada osteological collection of identified infants and young children

The objective of this study is to present the characteristics of a collection of identified infants and young children housed in the Laboratory of Anthropology of the University of Granada, Spain. The sample, which is still being enlarged, is currently composed of 230 complete skeletons aged from 5 months of gestation to 8 years, with a majority below 1 year. It mainly dates from the mid‐20th century. The state of preservation is very good, and antemortem information is available from burial and death certificates, among other documents. Our sample makes an important contribution to the relatively few collections available in the world for investigating the osteological development of the skeletons of infants and young children from a physical anthropological perspective. Am J Phys Anthropol, 2012. © 2012 Wiley Periodicals, Inc.