Morphological Characteristics of Healthy and Osteoarthritic Joint Surfaces in Archaeological Skeletons

Osteoarthritis is a major health concern in living populations, as well as being one of the most common pathological lesions identified in the archaeological record. The aetiology of the disease remains unclear, with a multi‐factorial influence of physical strain, age, genetics, and obesity. Previous studies have identified a relationship between the presence of knee osteoarthritis on the distal femoral joint and the morphology of the intercondylar notch, patellar groove, and medial condyle. The current study expands this research to investigate the relationship between distal femoral, distal humeral, and proximal ulnar joint morphology and osteoarthritis with 3D shape analysis techniques. These methods provide a more detailed analysis of joint morphology in order to determine any relationship between 3D shape and osteoarthritis. The results indicate a complex relationship between joint shape and knee osteoarthritis, with eburnated right femora showing a statistically significant association. The shapes associated with eburnated or affected femoral joints can be explained by osteophyte development, and therefore likely represent systematic shape changes and not a particular joint shape predisposing individuals to the condition. There was no identifiable relationship found in the proximal ulna or distal humerus, indicating that joint shape is unlikely to influence the development of the condition in the elbow joint and that any shape changes produced by osteoarthritis are not systematic or quantifiable. The joints analysed in this study were highly influenced by asymmetry, sexual dimorphism, and allometry, resulting in a small sample size of affected joints in many datasets. Further analyses of large skeletal samples are needed to more thoroughly investigate the possible relationship of distal femoral joint shape and osteoarthritis. Copyright © 2013 John Wiley & Sons, Ltd.     

Schmorl's nodes in a post‐medieval skeletal sample from Klostermarienberg,Austria

The prevalence and distribution pattern of Schmorl's nodes (SNs) were studied in a post‐medieval skeletal sample (n = 473) from the 16^th–18^th century cemetery of Klostermarienberg, Austria. The reasons for the prevalence and distribution pattern of SNs in this sample are discussed with regard to their aetiology. SNs were correlated with age and sex as well as with degenerative spinal joint disease such as vertebral osteophytosis (VO) and apophyseal osteoarthritis (OA). SNs were most commonly found in the lower thoracic region, in agreement with other studies. Males were more affected than females by SNs, especially in the lower thoracic region. SNs show a completely different distribution pattern to VO and OA. Additionally, there was no relationship found between SNs and ageing. Observed differences in the prevalence of SNs in the vertebral column and between the sexes suggest that mechanical factors may be responsible. Copyright © 2008 John Wiley & Sons, Ltd.     

Cribra orbitalia: a non‐human primate perspective

Cribra orbitalia, a porous lesion involving the orbital roofs, is one of the most‐studied skeletal pathologies in bioarchaeology, and yet uncertainty still exists regarding its aetiology and significance. In contrast to the hundreds of reports of cribra orbitalia in human skeletal remains, little is known of this condition in non‐human primates. Previously, cribra orbitalia has only been reported in catarrhines, with just two cases in cercopithecoids. To provide a broader, phylogenetic perspective on cribra orbitalia, a sample of primate skeletal material was examined to evaluate the occurrence of this condition. The taxonomically diverse sample consists of 380 non‐hominoid (non‐ape) modern primates from both wild and captive populations. Cribra orbitalia is present in 16 individuals, including cercopithecines, colobines, platyrrhines and a prosimian, substantially expanding the known taxonomic range of this condition. Modern primates—with their varied habitats, diets, levels of parasitism, etc.—provide a set of natural experiments regarding conditions and physiologies which may influence the aetiology and impact of cribra orbitalia. More generally, it is suggested here that studies of non‐human primate skeletal pathologies have the potential for providing significant insight on human paleopathologies. Copyright © 2009 John Wiley & Sons, Ltd.     

The periodontal disease status of the historical population of Assos

The science of anthropology obtains data on health, disease and death from ancient populations. Research on the skeletal remains of human teeth and surrounding tissues provides useful information on the evolutionary perspective of dental and periodontal diseases. The aim of this study was to determine the prevalence and severity of periodontal diseases in the skeletal remains of 33 Assos inhabitants of the 4th century BC. Three age groups were constituted for the studied population. Periodontal disease status was determined based on the textural and architectural variations of the interdental septum and the extent of bone loss. It was found that the prevalence of periodontal diseases increased with age. The severity of periodontal bone loss also increased with age and the mean alveolar bone loss between age groups was statistically significant (P = 0.004). This analysis of the dental health of ancient populations provides insights into the aetiology, patterns and distribution of periodontitis, which has a very complex disease pathogenesis. Copyright © 2005 John Wiley & Sons, Ltd.     

Scars of Parturition? Influences Beyond Parity

In the 40 years since the phrase ‘scars of parturition’ was coined, studies have attempted to show the relationship between scars on the bony pelvis and parity history. Despite numerous studies, the relationship of parity and scarring remains unclear. The challenge facing these studies is the rarity of skeletal collections of known parity. The alternative study approach is examining relationships between scars and factors other than pregnancy‐related strains that may affect their manifestation. Skeletal remains of 312 individuals were examined for scarring at the dorsal pubic surface, pubic tubercle, preauricular sulcus, interosseous groove and iliac tuberosity. Pelvic and femoral measurements were also taken. Features were compared according to sex and age. Principal components analysis was performed to assess the influence of body and pelvic size on scar manifestation. Scars occurred in both sexes, although they were more common and more severe in females. Scar severity remained unchanged or increased with age in both sexes. Females had smaller bodies but larger pelves than males. The interspinous and transverse inlet diameters and the femur measurements increased with age. Principal components analysis showed that body and pelvic sizes represented the majority of the observed variation, with scars occurring more commonly in small‐bodied individuals with large pelves, most of which were females. Both sexes also show a difference in the magnitude of scarring at the pubis and ilium. These results suggest that weight‐bearing and pelvic stability may be a better explanation for scarring than parturition‐related strain. Female pelves are more flexible and require more ligamentous stabilization, causing increased scar formation. The weight‐bearing strain on male pelves may sometimes also be sufficiently large to cause similar scars. Future studies may be able to test this theory on samples of known parity history. Copyright © 2014 John Wiley & Sons, Ltd.     

Osteoarthritis and body mass

Osteoarthritis is the second most common pathology found in anthropological collections. Although a great deal is known about osteoarthritis, it is not yet known whether in skeletal populations there is a correlation between osteoarthritis and body mass. In this study, lower limb and spinal osteoarthritis scores were taken to determine whether body mass and femoral length correlate with osteoarthritis on weight bearing joints. Osteoarthritis was measured using a four-point ordinal scale on a sample of 114 adult prehistoric Californian Amerinds. Body mass was calculated from femoral head breadth; femoral length was measured using standard procedures; and age and sex were determined through standard osteological procedures. Using Spearman correlations, body mass and femoral length did not correlate significantly with any of the osteoarthritis variables. Age correlated significantly with nearly all of the osteoarthritis variables (hip, r = 0.507; knee, r = 0.528; cervical, r = 0.513; thoracic, r = 0.647; lumbar, r = 0.507, P-values < 0.001); and body mass and femoral length correlated with sex (r-values = 0.835 and 0.654, P-values < 0.001). With age and sex controls, body mass negatively correlated with the hip osteoarthritis variable (r = −0.202, P < 0.05), but not with any of the other osteoarthritis variables. Results concur with previous findings in the anthropological literature and highlight complexities of osteoarthritis etiology.     

Evaluating human skeletal growth: An Anglo-Saxon example

Cross-sectional growth data were obtained from the skeletal remains of non-adults from the Raunds Anglo-Saxon site. Standard measurements of the diaphyseal lengths of the long bones of the upper and lower limbs and the maximum breadth of the ilium were recorded in order to construct skeletal growth profiles (SGP). In addition regression equations were used to estimate diaphyseal length from proximal and distal shaft widths, and epiphyseal breadth data for fragmentary remains. The skeletal measurements were then plotted against age estimates determined by the dental formation standards of Moorrees, Fanning and Hunt, and Anderson, Thompson and Popovich. The growth data were compared with sixth to seventh century German, ninth century Slavic and modern Caucasian data. With the exception of the ancient Slavic material, the Anglo-Saxon remains demonstrated the smallest rates of growth. Diaphyseal ageing curves derived from the Anglo-Saxon sample were tested for applicability on the non-adult cohorts of the Berinsfield and Exeter Anglo-Saxon/Early Medieval samples. Differences were observed between diaphyseal age as determined from the skeletal growth profiles for Raunds and calcification age assessed for individuals within the test samples. It is proposed that variation in long bone growth as well as dental age confounds consistent and reliable ageing of skeletal remains based on diaphyseal length. Assessment of changes in health and evaluation of methodological problems inherent to studies of skeletal growth from archaeological populations are discussed. Population comparisons for changes in general health are recommended over individual assessments.     

Skeletal distribution of degenerative changes in vertebral osteophytosis,vertebral osteoarthritis and DISH

In order to comprehend the condition of vertebral osteophytosis, vertebral osteoarthritis and DISH (diffuse idiopathic skeletal hyperostosis) with respect to diagnosis and aetiology, the vertebral and peripheral (appendicular) frequency and distribution pattern of degenerative joint changes of 176 rather affluent citizens were analysed from the late medieval city of Dordrecht in Holland. Patterns of frequencies with respect to age and sex were found to be similar essentially to those of a present-day Dutch suburban village population. Frequencies for vertebral osteophytosis were twice those for vertebral osteoarthritis, and both increased with age in both sexes. The individual pattern of vertebral osteophytosis and vertebral osteoarthritis seems to indicate that each disorder possesses its own progressive identity. From the distribution pattern and frequency of peripheral osteoarthritis it was concluded, with respect to the vulnerability of developing this complication under physically moderate life conditions, that causal factors for vertebral osteophytosis are less important than those for vertebral osteoarthritis. Osteoarthritis presented itself as a systemic disorder, affecting synovial joints in general. Finally it was appreciated that, with increasing age, bony outgrowths from joint degeneration become anatomically masked by para-articular ossifications from DISH.     

Dolnı́ Věstonice 15: Pathology and Persistence in the Pavlovian

Several lines of archaeological and human palaeontological data from the Moravian earlier Gravettian (or Pavlovian) indicate a high level of mobility among these earlier Upper Palaeolithic human populations. The congenitally abnormal young adult Dolnı́ Věstonice 15 human remains support this pattern. Dolnı́ Věstonice 15 suffered serious developmental abnormalities, most likely as a result of the X-linked dominant form of chondrodysplasia calcificans punctata, that included pronounced infantile and minor later childhood developmental defects of dental enamel (enamel hypoplasia), asymmetrical curvature and angular deformities of the proximal femora, asymmetrical shortening of the femora, a diaphyseal deformity of the distal right humerus, a probable healed left ulnar fracture with associated deformity of the radial diaphysis, elevated length asymmetries of the forearms, and an unusual pattern of anomalies of tooth position and number. These are combined with trivial intervertebral articular degenerations, plus localized pronounced osteoarthritis of the right glenohumeral joint and right second and fifth ray hand proximal interphalangeal joints. Yet, there is little asymmetry of the lower limbs distal of the mid-femora, and both diaphyseal hypertrophy of the humeri, femora and tibiae and relative arm and leg muscle attachment size and moment arms indicate a level of skeletal hypertrophy average to high for an earlier Upper Palaeolithic human. The severe upper limb osteoarthritis may indicate a pattern of pronounced and repetitive carrying or dragging of heavy loads. These data indicate the ability of the population to keep a severely affected individual alive through development, yet they also emphasize the necessity for all individuals to participate actively in the elevated mobility and overall activity levels of these earlier Upper Palaeolithic human populations.     

Age-dependent bone loss in the femur in a medieval population

Age-dependent bone loss in femurs in a medieval skeletal assemblage from Wharram Percy, England was studied. Dual energy X-ray absorptiometry (DXA) was used to measure bone mineral density (BMD) in the proximal femur; radiogrammetry was used to measure cortical index (FEMCI) at the femur mid-shaft. Age-related loss of BMD was found in the proximal femur in both sexes. Females but not males showed loss of FEMCI. Patterning in bone loss with respect to age, sex and site in the skeleton resembled that seen in recent subjects. In this respect the results are similar to those of a previous study of metacarpal cortical bone in the same archaeological assemblage. Given the large difference in lifestyles, and that lifestyle factors are widely held to influence the severity of bone loss in osteoporosis, the similarities between the medieval and modern populations in the patterns of bone loss are surprising. These findings support those from an earlier study of these skeletons in calling into question the role of lifestyle factors in influencing the severity of bone loss in osteoporosis. © 1998 John Wiley & Sons, Ltd.     

Using Enthesis Robusticity to Infer Activity in the Past: A Review

In bioarchaeological studies, entheseal change is commonly used to infer patterns of activity in past populations. This category of skeletal modification includes both pathological changes (enthesopathies) and changes in size, shape and surface complexity (robusticity). Despite the recent impetus to reassess the use of enthesopathies as markers of activity, robusticity has received little critical attention. In this review, we reassess key assumptions that underpin the use of robusticity in activity studies, drawing on anatomical, physiological, biomechanical and sports medicine literature sources. We find that, whilst there is some evidence to support the assumption that variation in enthesis robusticity reflects different activity patterns, little is known about the process through which this variation is produced. Presently, the stimuli (dynamics of muscle use or muscle size) for entheseal adaptation are ill-defined, a situation that limits our interpretive abilities. Consideration of bone functional adaptation principles and of the relationship of entheses to soft tissue also highlights how other factors, such as age, sex and genetic background, may influence enthesis robusticity and obscure activity-related adaptation. Understanding how these factors influence enthesis robusticity helps define how robusticity studies should be controlled, but further research is required to clarify how these factors interact with activity in robusticity development and the precise relationship between activity and robusticity. Ultimately, this review emphasises the complexity of entheseal structures and their morphological development. Any interpretation of activity from enthesis robusticity should be approached with caution, but in some circumstances, the endeavour may be ill-advised.     

The Effect of Terrain on Entheseal Changes in the Lower Limbs

One of the main factors involved in entheseal changes (EC) aetiology may be related to the physiological limits of biomechanical loading fixed during bone development, such that higher load during childhood and the adolescent growth spurt leads to a lower frequency of EC during adulthood. In this sense, it is possible that ECs may be related to overloading beyond an individual's normal physiological limits as established during childhood and adolescence. This meta‐analysis tested this aetiological possibility by studying the influence of terrain on the entheses of the lower extremities. The hypothesis is that individuals who inhabited rugged terrain have lower EC than those living in flat terrain. This is because biomechanical loads associated with rugged terrain will lead to a higher normal capacity (defined during skeletal development) mitigating the probability of overloading compared to those living in flat terrain who will therefore have a higher frequency of ECs. To test this, papers reporting EC frequencies in the lower limbs were analysed alongside the local terrain. Terrain was defined into two categories: flat or rugged based on altimetry profile, i.e. the average elevation gains and losses along four specific paths (North‐South, East‐West, Northwest‐Southeast, Southwest‐Northeast). Odds ratios were calculated to compare rugged and flat terrain. The overall results are consistent with the hypothesis that overloading is a factor in EC aetiology. However, when the analysis is conducted by sex and side, this general trend does not always occur. Limitations such as the lack of standardized age ranges could be affecting the outcome, i.e. older individuals have a higher frequency of ECs. The findings of this analysis suggest that the theoretical assumptions associated with the cause of ECs require further testing and evaluation. Copyright © 2017 John Wiley & Sons, Ltd.     

A palaeopathological investigation of the third intercondylar tubercle of Parsons

The third intercondylar tubercle of Parsons (TITP) is a bony protuberance which is sometimes present on the tibial plateau. It corresponds to the insertion of the anterior fibres of the anterior cruciate ligament (ACL). Reasons why TITP is present in some knees and not others are at present unclear. TITP is studied in knee joints from 68 adult individuals from a medieval cemetery. Associations are investigated with age, sex, knee osteoarthritis, clinical and subclinical DISH, and skeletal signs of trauma, with the aim of evaluating existing ideas on the causation of TITP. Only trauma showed an association with the presence of TITP. The results offer support for the aetiology of trauma to the ACL in the formation of TITP. Copyright © 2008 John Wiley & Sons, Ltd.     

Handedness and directional asymmetry in the long bones of the human upper limb

The long bones of the human upper limb usually show lateral asymmetries of length. This pattern can be attributed either to the mechanical consequences of handedness bias or to genetic or hormonal factors acting directly on longitudinal bone growth. Length data was obtained from the long bones of the upper limbs of a large skeletal assemblage from Wharram Percy, Yorkshire (England), predominantly deriving from the 11th-16th centuries A.D. The Wharram Percy adult skeletons had a population distribution of lateral asymmetries of length in the humerus and in the humerus-plus-radius (a proxy arm length index) which closely parallels the pattern of behavioural handedness found in modern populations. This pattern was developing in the skeletons from the infant and juvenile age ranges, but was absent in the neonates (of whom 12 out of 14 had longer left humeri). We argue that this supports the environmental hypothesis that the ontogeny of long bone length asymmetry is consequent to the earlier development of lateral bias in mechanical loading of the upper limbs.     

Microscopical findings associated with the diagnosis of osteoporosis in palaeopathology

This paper presents some preliminary results on microscopical identification of microfractures in human skeletal remains which may be associated with osteoporosis. A technique is described for the examination of cancellous bone and applied to a number of vertebrae and one radius. All the material used is Romano-British or English medieval. However, microscopical screening for osteoporosis could form a useful part of comparative studies on historically or geographically different populations. The archaeological significance of osteoporosis in terms of skeletal ageing and nutritional status is discussed.     

DISH and the monastic way of life

Diffuse idiopathic skeletal hyperostosis (DISH) is common condition and its prevalence increases markedly with age. This paper describes the pathology and aetiology of the condition; DISH seems to be related to obesity and type II diabetes and is probably a multisystem hormonal disorder. DISH occurs frequently in human skeletal remains, particularly in those recovered from monastic sites. Evidence is presented to confirm this association and the causes are discussed. We also present criteria for the diagnosis of DISH in human remains, which we suggest would permit valid inter‐study comparisons. Copyright © 2001 John Wiley & Sons, Ltd.     

Thalassemia: macroscopic and radiological study of a case

Differentiation of the genetic and the acquired anaemias, particularly in areas of the world where they may co‐exist, has been a challenge for palaeopathologists for over 100 years. In this paper we present macroscopic and radiographic skeletal lesions that are associated with the thalassemias in a 14‐year‐old girl from a modern reference collection of the University of Athens. This individual is of known sex, age, cause of death, place and dates of birth and death. The case is examined in terms of epidemiology, growth, distribution and severity of lesions and differential diagnosis. The entire skeleton is affected by marrow hyperplasia: lesions of the axial skeleton are extreme, and the appendicular skeleton is severely affected as well. The odontofacial manifestations that are diagnostic of thalassemia and differentiate it from other anaemias are present and include: maxillary and mandibular hyperplasia, reduced sinuses, displacement of maxillary dental structures, overbite, and generalised osteopenia. The development of extreme bone lesions and the ‘advanced’ age‐at‐death of this individual is explained as either the result of thalassemia major under a low transfusion regimen that was the norm during her lifetime, or to a form of thalassemia intermedia that allows survival to later life at the expense of gross skeletal alterations. The present status of skeletal studies in Greece does not support the identification of a genetic anaemia in past populations. The potential contribution of the current analysis in differentiating the anaemias in antiquity is evaluated. Copyright © 2006 John Wiley & Sons, Ltd.     

The Occurrence and Possible Aetiology of Spondylolysis in a Pre‐contact California Population

The occurrence of spondylolysis (neural arch separation at the pars interarticularis) is reported in a pre‐contact (720–550 Cal BP) Central California population, CA‐CCo‐647 (n = 46). Spondylolysis was examined within this population to assess differences in sex, age, and possible relationships with biological affinity. Furthermore, prevalence rates of spondylolysis were compared across various populations to discern the aetiology of the defect. Within CA‐CCo‐647, spondylolysis was found in 17.4% (8/46) of the population. All occurrences are complete, bilateral separations of the neural arch in the lower lumbar (L4 and L5). The defect is not seen in individuals below the age of 18, and there is no correlation between adult age and spondylolysis. Male individuals display the defect at a higher rate (30.8% ‐ 4/13) than female individuals (12.1% ‐ 4/33); however, this is not a statistically significant finding. There does seem to be a correlation between an individual's sex and the onset of the defect; male individuals display spondylolysis at a younger age than female individuals. This finding could represent differences in activity patterns among young male and female individuals. In a biological distance analysis using craniometric data, male and female individuals with spondylolysis clustered closely, suggesting a genetic component for the defect. Finally, significant differences were found in spondylolysis prevalence between various populations representing distinct geographic and temporal settings. Significant differences were found among Native pre‐contact samples and even between two comparable pre‐contact California skeletal samples. These populations all engaged in distinct activities and were likely composed of genetically distinct groups of individuals, which may account for the differences in spondylolysis prevalence. All of these findings, both within CA‐CCo‐647 and between the various samples, suggest that the aetiology of spondylolysis is likely an interaction of genes and activity. Copyright © 2012 John Wiley & Sons, Ltd.     

Diagnostic criteria for developmental dislocation of the hip in human skeletal remains

Dislocation is the most severe form of developmental dysplasia of the hip (DDH). It significantly impairs hip function in the young, and may lead to debilitating early‐onset osteoarthritis in adults. To our knowledge no thorough study of a large skeletal population has ever been undertaken to determine the wide range of diagnostic criteria for this condition in pathological specimens. To identify these criteria we have analysed the cases of developmental dislocation from a large series of 6000 individuals (6580 hips) from the medieval cemetery at Spitalfields in London, UK. We describe the changes at the true acetabulum, and have created a four‐stage classification of the false acetabulum. The skeletal response to the altered biomechanics and limb shortening that occurs in developmental dislocation is described in the pelvis, lower limb and spine. This includes asymmetric growth in childhood, and asymmetric degenerative change in adulthood. We conclude with a discussion of the clinical literature on developmental dislocation of the hip that will aid palaeopathologists to estimate the symptoms that an excavated individual may have experienced during their lifetime. Copyright © 2007 John Wiley & Sons, Ltd.     

Is the evaluation of millennial changes in stature reliable? A study in southern Europe from the Neolithic to the Middle Ages

Analyses of stature variation in prehistoric and historical populations encounter considerable problems of reliability of the comparisons. To properly compare the results of different studies, it is necessary to conduct a systematic review of the chronological and cultural context of the skeletal series used and identify the most appropriate method to calculate stature values, since stature reconstruction formulae are specific for certain times and places. Stature variations in the population of Sardinia (a Mediterranean island now part of the Italian Republic but considered separately given its unique genetic structure) from the Neolithic to the Modern Period were studied to evaluate the intensity of millennial changes. The results were then compared with the values of coeval skeletal series reported in the literature for other Southern European countries (Italy, Spain, Portugal). We used Sardinian skeletal series with radiocarbon dates or from culturally well-defined archeological contexts. The osteometric measurements were taken on femora of adults who had completed growth and who did not present evident pathological conditions. The data we collected and analyzed indicate that the conditions are lacking to reliably identify a common trend in millennial changes among the considered populations of southern Europe.