Vertebral Compression Fractures: Towards a Standard Scoring Methodology in Paleopathology

Vertebral compression fractures are the most common osteoporotic fractures in postmenopausal women. Notwithstanding, its clinical diagnosis remains ambiguous. In paleopathological studies, vertebral fractures and/or deformations are frequently disregarded. When observed, vertebral compression fractures are usually recorded without the support of quantifiable and comparable protocols. As such, Genant's semi‐quantitative method for vertebral compression fracture assessment was applied to a large sample (N = 196) from the Coimbra Identified Skeletal Collection, Portugal, and the reliability of the method was tested. Vertebral fracture scoring agreement was evaluated with the kappa statistic and the per cent of agreement. Intra‐observer agreement was almost perfect, whereas inter‐observer agreement was substantial to almost perfect. The Genant's semi‐quantitative scoring methodology is easy to apply and highly reproducible; as such, it should be adopted as the standard method to score vertebral fractures in any paleopathological investigation. Copyright © 2014 John Wiley & Sons, Ltd.     

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.     

An investigation of historical and archaeological evidence for age‐related bone loss and osteoporosis

A growing awareness of the problems caused by osteoporosis‐related fractures has led to increased investigation of the condition in past populations. The present study seeks to examine the ways in which osteoporosis‐related fractures may be explored through different approaches; modern clinical information, historical records of fractures and analysis of archaeological bone may provide fuller information on the condition. The three types of fractures upon which this study focuses are fractures of the femoral neck, Colles' fractures and vertebral compression fractures. The results of the investigation clearly demonstrate the way in which the various sources produce a slightly different picture of the condition. The archaeological significance of the different types of fractures was found to be the reverse of that which would be suspected in the light of information derived from historical sources and the clinical literature. To date vertebral crush fractures have been the most commonly found osteoporosis‐related fracture in archaeological material, but their significance to people in the past is likely to have been minimal. In contrast hip fractures have rarely been reported from archaeological bone material, but historical information makes it clear they were well known, and knowledge derived from clinical sources emphasizes the serious consequences of such a fracture for the affected individuals. The results indicate the value of undertaking a multi‐disciplinary approach where possible. Copyright © 2002 John Wiley & Sons, Ltd.     

Osteoporosis among ancient Egyptians

Osteoporosis is a condition of reduced total bone mass per unit volume for the normal ratio of bone mineral to bone matrix. The present work deals with the investigation and evaluation of osteoporosis in ancient Egyptians of two social classes from the Old Kingdom in Giza. The aims of this study are to provide information about the lifestyle and health status of ancient Egyptians, and to detect the causes of osteoporosis. The material consisted of 74 skeletons (43 males and 31 females) from two different social classes (high officials and workers). Skeletons were excavated from the Giza Necropolis and belonged to the Old Kingdom (2687–2191 BC). Dual energy X‐ray absorptiometry (DEXA) was used to measure bone mineral density (BMD) at different skeletal sites (radius, fourth lumbar vertebra and head of femur). Moreover, scanning electron microscopy (SEM) was used to show the microarchitectural structure of the bone. Results showed a significant decrease of BMD values in old age groups compared with younger ones in both sexes. In addition, SEM of trabecular bone in osteoporotic cases demonstrated that the horizontal trabeculae were more affected than the vertical trabeculae. Comparison between high officials and workers revealed that osteoporosis was more frequent in male workers than in male high officials, and in female high officials than in female workers. An elevated prevalence of osteoporosis among male workers may be related to the effects of nutritional stress and excessive workload, while a sedentary lifestyle may have played a role in the occurrence of osteoporosis among female high officials. Moreover, osteoporosis occurs earlier and more frequently in females than males, which may be related to the hormonal changes that accompany the menopause in females. This study emphasises the importance of gender and lifestyle factors in influencing the severity of osteoporosis. Age‐related bone loss at most skeletal sites is noted in both sexes of ancient Egyptians. Copyright © 2008 John Wiley & Sons, Ltd.     

Bone mineral densities in the prehistoric,Viking‐Age and medieval populations of Norway

Osteoporosis is a prevalent condition in Norway, as evidenced by the fact that this country has the highest reported incidences of hip and distal forearm fractures. Because recent studies suggest a higher bone density in rural populations compared with urban ones, increased physical activity is believed to be an important factor in reducing fracture incidence. In the present investigation, 185 femoral necks from the Schreiner Collection in Oslo were measured by means of a bone‐mass scanner. The bones, anthropological specimens ranging from the Stone Age to the Middle Ages, were separated into three groups: prehistoric (n = 36), Viking Age (n = 38) and medieval (n = 111). The medieval group was further separated into urban, rural and monastic populations. The examination showed that: (a) there was no significant difference at a 5% level in average bone mineral density (BMD) between the male and female material; (b) there was no significant difference in average BMD among the prehistoric, Viking Age, and medieval periods (P = 0.151); (c) there was no significant difference in average BMD between the rural and urban medieval material; (d) there was a significant difference in average BMD only between the monastic and the rural medieval material; (e) only the medieval material showed a significantly higher average BMD than that of today (P = 0.001). These findings may indicate that factors in addition to physical activity are important for normal BMD maintenance. Copyright © 2006 John Wiley & Sons, Ltd.     

Extreme osteoporosis in a sixth century skeleton from the Negev desert

Osteoporosis was probably rare in ancient times due to the short life expectancy. An extremely osteopaenic skeleton of an adult female who lived in the Negev Desert c. AD 500 was studied using radiology, bone densitometry and histomorphometry. Possible aetiologic factors are discussed, with special emphasis on calcium and/or vitamin D deficiency, because nutritional deficiency has been described in Bedouin women who retain traditional dietary habits resembling those prevalent in the Negev region in antiquity.     

Compensatory bone remodelling in moose: a study of age,sex, and cross‐sectional cortical bone dimensions in moose at Isle Royale National Park

We studied interrelationships among age, sex, and cross‐sectional cortical bone dimensions using quantitative computed tomography (QCT) scans of metatarsal bones of 180 moose (Alces alces) that died in Isle Royale National Park, Michigan. As a large‐bodied quadruped with demanding ecological constraints on movement and behaviour, a moose experiences different weight‐bearing and mechanical stressors than humans, to whom most existing studies of mechanical adaptations of bone pertain. In moose, both sexes showed significant subperiosteal expansion and an increase in medullary area, with an overall increase in cortical bone area over time. Female moose did not exhibit cortical thinning or reduction in cross‐sectional area with age, rather they showed an increase in cortical bone area with periosteal apposition exceeding endosteal resorption, similar to the males. We also found that moose undergo changes in bone geometry through remodelling of bone similar to humans, suggesting a compensatory mechanism for increasing bone strength under conditions of decline in bone mineral density with age. Copyright © 2002 John Wiley & Sons, Ltd.     

The Meul Index: A non‐destructive method for estimating the cortical index in skeletal samples

The study of osteoporosis in past populations provides insight into the history and evolution of this condition. The Cortical Index is a relative measure of cortical bone often used for identifying individuals with age‐related bone loss associated with osteoporosis. Current methods of measuring the Cortical Index involve radiography or cutting actual sections of long bones at the mid‐shaft. We propose a new index, the Meul Index as means for estimating the Cortical Index without the use of radiography. Based on a preliminary study of 13 individuals consisting of 9 males, 3 females and one unknown sex, ranging in age from young to older adult, the Meul Index is highly correlated with the Cortical Index (r = 0.903). The proposed Meul Index provides a non‐destructive and inexpensive means for studying age‐related bone loss in prehistoric and historic populations represented by skeletal samples. Our research builds on the recent publication of Silva, A.M., Crubezy, E. and Cunha, E. 2008. Bone weight: new reference values based on a modern Portuguese identified skeletal collection. Int. J. Osteoarchaeol. DOI: 10.1002/oa.998. Copyright © 2009 John Wiley & Sons, Ltd.     

Bone density determination of moose skeletal remains from Isle Royale National Park using digital image enhancement and quantitative computed tomography (QCT)

As part of an investigation of prey vulnerability in Isle Royale National Park, MI, digital image processing techniques were used to enhance original quantitative computed tomography (QCT) film products to detail the processes of bone resorption and reformation in skeletal remains of moose (Alces alces). Integration of these two allied imaging technologies allowed analyses of pixels representing fractions of millimetres of bone. Using regression analysis, linear conversions from the pixel digital numbers (DN) to QCT Hounsfield units (HU) to actual bone mineral density (BMD) values were calculated (r²=0.99), and a scale of pixels per millimetre of bone was determined. The colour-enhanced image revealed quantifiable patterns of density, porosity and asymmetry. In addition, the procedure provided a quick but consistent methodology for evaluating numerous scans. Combining the limited use of a high-demand and expensive medical QCT scanner with a lower cost, readily available digital image processing and analysis system provides a technique for researchers to investigate the bone integrity of individual animals and populations. This method of evaluating bone density has implications for use in determining differential skeletal part-preservation in archaeofaunal studies. © 1997 John Wiley & Sons, Ltd.     

A Large‐Scale Palaeopathological Study of Hip Fractures from Post‐Medieval Urban England

Hip fractures have high incidence rates in many current groups and are associated with high morbidity, mortality, and considerable expenditure. Although hip fractures associated with significant traumatic events can occur at any age, many hip fractures occur in older adults. To date, few hip fractures have been reported from archaeological skeletal material, and a number of hypotheses have been suggested for this. This research presents a comprehensive assessment of hip fractures in archaeological bone; 1597 adult (18+ years) skeletons from eight urban post‐medieval sites from England dating from the 18^th and 19^th centuries were recorded, and contemporary medical texts reviewed. This adult sample included 834 males and 652 females as well as 11 persons of undetermined sex. Ways of classifying and describing fractures in the clinical literature were reviewed and a methodology applicable to paleopathology determined. Of this sample, 15 (0.94%) had fractures in the femoral neck or intertrochanteric area: nine males, four females, and two individuals of undetermined sex. The numbers of fractures in males were interesting and most likely represent examples of accidental trauma as well as osteoporosis‐related fractures, the latter receiving growing awareness in recent clinical literature. Overall there was an age‐related trend with more individuals aged 50+ years with fractures than in other age categories. Underlying osteoporosis was potentially a complicating factor in five individuals and was likely associated with a vitamin D deficiency osteomalacia and a metastatic neoplastic condition in a further two cases. Fractures occurring close to the time of death and healed fractures were observed, indicating that the risk of mortality following this trauma was not consistent across this 18^th and 19^th century sample. Skeletal and historical evidence presented in this study indicate that the impact of hip fracture injuries varied, with survival likely linked to the fracture type. Copyright © 2016 John Wiley & Sons, Ltd.