Metabolic diseases in Andean paleopathology: Retrospect and prospect.

John Verano's 1997 synthesis of Andean paleopathology guided two decades of research and was instrumental in establishing modern Andean paleopathology. This paper reviews the current state and new directions in the study of skeletal metabolic disorders in the Central Andean archaeological record. Key historical, ecological, methodological, and contextual issues intersect with the study of metabolic bone diseases in Andean paleopathology. This paper further examines known temporal and spatial distribution of these disorders, as well as the strengths and weaknesses of the record of linear enamel hypoplasias, cribra orbitalia, porotic hyperostosis, scurvy, and rickets. Many other metabolic bone diseases have yet to be documented such as pellagra, hypophosphatasia, osteomalacia, and mucopolysaccharidosis among others. This work closes with considerations in the search for these undocumented diseases, but such an effort is only one part of new wave of advancements just on the horizon. The study of metabolic diseases in Andean paleopathology can lead the development of more sophisticated approaches to data collection, analysis, and interpretation - especially regarding theoretical interpretations from various bodies of social theory to the Developmental Origins of Health and Disease hypothesis, life history approaches, and phenotypic adaptive plasticity and constraint.

A microscopic evaluation of Paget's disease of bone from a Byzantine monastic crypt in Jordan.

Paget's disease of bone (PDB) is a metabolic bone disease that has been present in human populations for over 2000 years, with the earliest cases reported in Western Europe. Now present globally, PDB is one of the most common metabolic bone diseases in modern populations. This study details possible PDB of an adult male (MNR-EN Skull 3) with abnormally thickened cranial bones (17 mm). The skull was recovered from commingled skeletal remains excavated from the Robebus crypt at the Byzantine monastery of Mount Nebo, Jordan (c. late 4-7th C). Micro-CT imaging and histological sections of the bone samples revealed an abnormal pattern of bone remodeling, with atypical osteon formation, convoluted and enlarged trabeculae, and an overall pattern of highly vascularized bone. Polarized microscopy produced a mix of woven bone and lamellar bone, the mosaic pattern of atypical bone remodeling indicative of PDB. Coupled with the dense, thickened nature of the vault bones, these data suggest that the individual had PDB. To our knowledge, this represents the earliest evidence of PDB in the Middle East supported by micro-analysis, and adds to the emerging paleopathological literature involving commingled skeletal remains and the potential for identifying unique disease processes.

Paradise lost: Evidence for a devastating metabolic bone disease in an insular Pleistocene deer.

PURPOSE: This communication reports skeletal pathology in a Pleistocene endemic deer from the Mavromouri caves of Crete. MATERIALS: 287 bones and bone fragments from Mavromouri caves are compared to 2986 bones from Liko Cave. METHODS: Bones were evaluated macroscopically, and measurements were made of morphometric characteristics of limb long bones. Representative bone specimens were examined radiographically and histologically. RESULTS: Macroscopic hallmarks were loss of bone mass and increased porosity. The long bones were brittle, some of them having thin cortices, and others reduction of medullary cavities that contain dense Haversian tissue. The flat bones were spongy and fragile. Erosions of the metaphyses and articular surfaces were noted. Histological findings included: sub-periosteal resorption; loss of lamellar bone; enlargement of vascular canals; and remodeling of cortical bone. Two types of fibrous osteodystrophy were recognized in skeletal remains, subostotic and hyperostotic. CONCLUSIONS: The deer of Mavromouri caves were affected by severe metabolic bone disease, likely nutritional secondary hyperparathyroidism. We hypothesize a multifactorial cause, including overgrazing, flora senescence, soil mineral deficiencies, and a prolonged period of climate extremes, degrading the Cretan deer habitat. VALUE: This is the first evidence of a metabolic bone disease causing this level of destructive pathology in an insular fossil deer. LIMITATIONS: The lack of absolute chronometric dates for the site limits potential linking with the prevailing environmental conditions. SUGGESTIONS FOR FURTHER RESEARCH: Investigation of similar skeletal pathologies at other islands or isolated habitats is advised.

Renal Osteodystrophy-Time for Common Nomenclature.

PURPOSE OF REVIEW: The term renal osteodystrophy has been used to describe a wide variety of bone problems facing patients with chronic kidney disease (CKD). Here, we review the history of the use of this term. RECENT FINDINGS: Bone disease resulting from CKD was first noticed in 1890. The term "renal osteodystrophy" was used to define the bone disease in 1942. Since then, important discoveries have increased our knowledge of the complexities of bone physiology in these patients. At the same time, secular changes in the disease have occurred. The terms used to describe the bone histological findings have changed as well, reflecting new understanding of the physiological processes. However, since different investigators used the terms in different ways, the need to standardize the nomenclature has become increasingly important. Ongoing international collaboration about nosography will allow more optimal communication among scientists and clinicians as we continue to make new discoveries.

Mechanical and metabolic interactions in cortical bone development.

OBJECTIVES: Anthropological studies of cortical bone often aim to reconstruct either habitual activities or health of past populations. During development, mechanical loading and metabolism simultaneously shape cortical bone structure; yet, few studies have investigated how these factors interact. Understanding their relative morphological effects is essential for assessing human behavior from skeletal samples, as previous studies have suggested that interaction effects may influence the interpretation from cortical structure of physical activity or metabolic status. MATERIAL AND METHODS: This study assesses cross-sectional geometric and histomorphometric features in bones under different loading regimes (femur, humerus, rib) and compares these properties among individuals under different degrees of metabolic stress. The study sample consists of immature humans from a late medieval Lithuanian cemetery (Alytus, 14th-18th centuries AD). Analyses are based on the hypothesis that metabolic bone loss is distributed within the skeleton in a way that optimizes mechanical competency. RESULTS: Results suggest mechanical compensation for metabolic bone loss in the cross-sectional properties of all three bones (especially ribs), suggesting a mechanism for conserving adequate bone strength for different loads across the skeleton. Microscopic bone loss is restricted to stronger bones under high loads, which may mitigate fracture risk in areas of the skeleton that are more resistive to loading, although alternative explanations are examined. DISCUSSION: Distributions of metabolic bone loss and subsequent structural adjustments appear to preserve strength. Nevertheless, both mechanics and metabolism have a detectable influence on morphology, and potential implications for behavioral interpretations in bioculturally stressed samples due to this interaction are explored. Am J Phys Anthropol 160:317-333, 2016. © 2016 Wiley Periodicals, Inc.

From aging to pathology: the case of osteoporosis.

In the 1940s, osteoporosis was a narrow diagnosis that referred to postmenopausal women with nontraumatic vertebral fractures. During and after the 1980s, it was invested with new meanings. Rather than being an aspect of the normal aging process, bone loss became pathological. New scanning technologies and the development of numerical scales hastened the process of change. The lowering of the numerical threshold for the diagnosis resulted in a recommendation that virtually all elderly persons be screened and undergo treatment. The transformation of this diagnosis into a major health problem provides an illustrative case study of the interrelationships between perceptions of aging, the celebration of youth, gender, the role of the medical care system and the pharmaceutical industry, the commercialization of health care, as well as a variety of social, scientific, and technological currents.