Sex differences in the patterning of age-related bone loss in the human hallucal metatarsal in rural and urban populations.

OBJECTIVES: Age-degenerative features of the metatarsals are poorly known despite the importance of metatarsal bone properties for investigating mobility patterns. We assessed the role of habitual activity in shaping the patterning and magnitude of sexual dimorphism in age-related bone loss in the hallucal metatarsal. MATERIALS AND METHODS: Cross-sections were extracted at midshaft from micro-computed tomography scan models of individuals from medieval rural (Abingdon Vineyard) and early industrial urban (Spitalfields) settings (n = 71). A suite of cross-sectional geometry dimensions and biomechanical properties were compared between populations. RESULTS: The rural group display generally stronger and larger metatarsals that show a greater capacity to resist torsion and that have comparatively greater bending strength along the medio-lateral plane. Men in both groups show greater values of cortical area than women, but only in the urban group do men show lower magnitudes of age-related decline compared to females. Women in rural and urban populations show different patterns of age-related decline in bone mass, particularly old women in the urban group show a marked decline in cortical area that is absent for women in the rural group. DISCUSSION: Lifetime exposure to hard, physical activity in an agricultural setting has contributed to the attainment of greater bone mass and stronger bones in young adults. Furthermore, over the life-course, less of this greater amount of bone is lost, such that sustained activity levels may have acted to buffer against age-related decline, and this is most pronounced for women, who are expected to experience greater bone loss later in life than men.

A multi-method assessment of bone maintenance and loss in an Imperial Roman population: Implications for future studies of age-related bone loss in the past.

OBJECTIVES: One of the hallmarks of contemporary osteoporosis and bone loss is dramatically higher prevalence of loss and fragility in females post-menopause. In contrast, bioarchaeological studies of bone loss have found a greater diversity of age- and sex-related patterns of bone loss in past populations. We argue that the differing findings may relate to the fact that most studies use only a single methodology to quantify bone loss and do not account for the heterogeneity and complexity of bone maintenance across the skeleton and over the life course. METHODS: We test the hypothesis that bone mass and maintenance in trabecular bone sites versus cortical bone sites will show differing patterns of age-related bone loss, with cortical bone sites showing sex difference in bone loss that are similar to contemporary Western populations, and trabecular bone loss at earlier ages. We investigated this hypothesis in the Imperial Roman population of Velia using three methods: radiogrammetry of the second metacarpal (N = 71), bone histology of ribs (N = 70), and computerized tomography of trabecular bone architecture (N = 47). All three methods were used to explore sex and age differences in patterns of bone loss. RESULTS: The suite of methods utilized reveal differences in the timing of bone loss with age, but all methods found no statistically significant differences in age-related bone loss. DISCUSSION: We argue that a multi-method approach reduces the influence of confounding factors by building a reconstruction of bone turnover over the life cycle that a limited single-method project cannot provide. The implications of using multiple methods beyond studies of bone loss are also discussed.

X-ray, CT and DXA study of bone loss on medieval remains from North-West Italy.

PURPOSE: The aim of this study was to investigate whether the population differences in osteoporosis observed nowadays is a reflection of the times and modern lifestyle factors, or whether they were also present in the past. MATERIALS AND METHODS: The study was performed on the skeletal remains of medieval and post-medieval populations from a burial ground in the North-West of Italy. Some individuals had been buried inside the church (privileged subjects), others outside in the parvis (members of rural population), and others still to the north of the church. X-ray, computed tomography and dual-energy X-ray absorptiometry studies were carried out on the lumbar spines and/or femurs of 27 male and 28 female individuals to determine any associations between cortical index, bone mineral density (BMD), gender, age and social status. RESULTS: No statistically significant differences were observed in cortical index values according to gender, age or place of burial. Conversely, statistically significant differences in average BMD values were observed according to place of burial; in particular, among those buried inside the church, a lower BMD was observed compared to the parvis group (1.09 vs. 1.42, p < 0.001) and the north group (1.09 vs. 1.49, p < 0.001). CONCLUSIONS: The differences observed in the BMD values may be related to the different lifestyle of the rural population, i.e. more dietary calcium intake, more sun exposure and vigorous physical activity, compared to that of the privileged individuals.

Age-associated reduction in cortical bone in males, trends from the third century AD to the present day.

Osteoporosis is increasingly recognised as a health threat in the ageing male. Risk factors for osteoporosis appear to have increased through time. This study investigates the hypothesis that lifestyle changes (e.g. increasing sedentism, tobacco use) over the past 1,800 years have resulted in greater age-related reduction in cortical bone in males in more recent compared with earlier times in England. Skeletons (N = 215) from three English archaeological sites dating from the third to nineteenth century AD, together with comparison with a modern reference population, are used to investigate this hypothesis. Metacarpal cortical thickness is used as a measure of cortical bone status. Results of this cross-sectional study do not support the above hypothesis but instead suggest that patterns of age-related reduction in cortical bone in males have remained stable over an 1,800 year period.

Osteoporosis and paleopathology: a review.

Osteoporosis is a complex and heterogeneous disorder, of multi-factor aetiology. It is the most frequent metabolic bone disorder, affecting an increasing number of post-menopausal women and aging individuals from both sexes. Although first recognized more than 250 years ago, the clinical and epidemiological knowledge about osteoporosis is largely limited to the last 70 years. Within the conceptual frames of paleopathology, disease is necessarily perceived in a space without depth (the skeleton) and of coincidence without development (the crucial moment of death) -but is also interpreted in a time interval which adds an historical gaze to its "biography". The study of osteoporosis in past populations (which faced sociocultural conditions utterly different from the genus vitae experienced by modern communities) supplements diachronic depth to the knowledge about bone modifications related to age, menopausal status or lifestyle. This article aims to provide a comprehensive record on the history of osteoporosis and fragility fractures as perceived by the biomedical, historical and, particularly, paleopathological sciences. As such, the main focus of this review is to present an exhaustive and historical-framed exposition of the studies of osteoporosis, bone loss and associated fractures within the field of paleopathology and, to a lesser extent, in the history of medicine. A biomedical-oriented synopsis of the main operational definitions, etiological agents and epidemiological features of osteoporosis and osteoporotic fractures is also provided.

The phosphorous necrosis of the jaws and what can we learn from the past: a comparison of "phossy" and "bisphossy" jaw.

INTRODUCTION: The osteopathology of the jaws associated with bone resorption inhibitors is a current topic that engages a variety of clinical specialists. This has increased after the approval of denosumab for treatment of osteoporosis and skeletal-related events in patients with solid malignancy. Early after the first publications, there is a possible connection between phosphorous necrosis of the jaws, a dreadful industrial disease mentioned, and bisphosphonate-induced pathology. The nineteenth century was the prime time for phosphorus necrosis of match factory workers. RESULTS: This occurrence provides an interesting insight into the medical and surgical profession in the nineteenth century. There are striking parallels and repetition of current and old ideas in the approach to this "new disease." There are similar examples in case descriptions when compared with today's patients of bisphosphonate-related osteonecrosis of the jaws (BRONJ). DISCUSSION: Phosphorus necrosis was first described in Austria. Soon after this, surgeons in German-speaking countries including well-known clinicians Wegner (1872) and von Schulthess-Rechberg (1879) pioneered the analysis, preventative measures, and treatment of this disease. The tendency at this time was to approach BRONJ as a "special kind of osteomyelitis" in pretreated and metabolically different bone. Not only the treatment strategy to wait until sequestrum formation with subsequent removal and preventative measures but also the idea of focusing on the periosteum as the triggering anatomical structure may have been adopted from specialists in the nineteenth century. Therefore, phosphorous necrosis of the jaw is an excellent example of "learning from the past."

Osteobiography of a 19th century elderly woman with pertrochanteric fracture and osteoporosis: a multidisciplinary approach.

In this paper the osteobiography of an elderly woman recovered from a cemetery tomb where she was buried in 1850, affected by hip fracture and osteoporosis, is described. The overall anthropological characteristics of the individual have been investigated. Macroscopic, radiographic, tomographic, microscopic, and chemical and structural examinations have been performed to give a detailed account of the condition of the skeleton. A non-union pertrochanteric fracture not surgically treated and probably due to senile osteoporosis was diagnosed. The consequences of the fracture to the bones show that this individual likely survived several years following the injury. The osseous features we describe (remodelled bone at the fracture site, asymmetry of entheseal changes likely related to the particular walking pattern of the individual) may be useful in personal identification of skeletons of legal interest. Regarding the recognition of osteoporosis in unearthed skeletons, our study underlines that the cortical thickness, microscopic features, degree of crystallinity and Ca/P ratio represent more useful elements than the mean bone density, mineral/matrix ratio and mineral maturity, which are more sensitive to diagenetic changes that affect the mineral phase post-mortem.

The history of osteoporosis: why do Egyptian mummies have porotic bones?

Paleopathologists have identified osteoporosis in ancient skeletons and modern physicians and scientists have identified risk factors for osteoporosis today, but they are not clearly linked, making it more difficult to clarify the causes of osteoporosis in the past. The evidence for osteoporosis in the remote past, its causes, and the management of this disease is reviewed in the light of evolving and improving diagnostic modalities, more precise definitions, and the recent rapid expansion of therapeutic options. While the specific effects of parity and lactation on the development of osteoporosis are still not entirely clear, duration of reproductive span and age at first pregnancy appear to be significant predisposing factors.

Hand osteoarthritis and bone loss: is there an inverse relationship?

An inverse relationship between osteoarthritis (OA) and bone loss has been supported in clinical research, but there has been little research on bioarchaeological skeletal remains. The current study examines 115 adults from a prehistoric hunter-gatherer population to aid in determining whether hand OA and bone loss are negatively correlated. OA lipping is scored on a four-point scale on left and right trapezia, MC1s, and MC2s and then analyzed with regard to their relationships with sex, age, right MC2 cortical index, and left and right MC1 robusticity, midshaft circumference, and midshaft diameter values. With sexes and ages combined, higher OA scores are found in individuals with greater midshaft diameters. However, lower cortical indices were found in individuals with higher right MC2 OA scores. The data presented tenuously support that bone loss is lower in individuals with more severe osteoarthritis, but age-related changes in bone deposition may make cortical index and other external shaft dimensions an unsuitable variable to examine this relationship.

Paleopathological findings in radiographs of ancient and modern Greek skulls.

OBJECTIVE: The skull, when portrayed radiologically, can be a useful tool in detecting signs of systemic diseases and results of pathological growth mechanisms. The aim of this study was therefore to examine, compare, and classify findings in cranial configuration of pathological origin, in modern and ancient skulls. MATERIALS AND METHODS: The material consists of 240 modern and 141 ancient dry skulls. Three radiographs for each skull (lateral, anteroposterior, basilar) provide enough evidence for differential diagnoses. RESULTS: Cases of osteoporosis are among the interesting pathological findings. A prevalence of female modern skulls in those determined as osteoporotic skulls is noted. Special interest is placed on the area of the sella turcica and many variations, regarding the shape and texture, are recognized both in ancient and modern skulls. Malignancies and important causes of cranial destruction are identified in both skull collections. Diploid thickening and osteolytic areas appear commonly among ancient remains. Moreover, from the ancient skull collection, one case possibly recognizable as fibrous dysplasia is noted while another case with an unusual exostosis gives rise to many questions. CONCLUSIONS: Interpreted with caution, the results of the present study, which can serve as an approach of paleopathology and paleoradiology, indicate similarity trends in cranial configuration of pathologic origin in modern and ancient people. Radiography and cephalometry were the main diagnostic tools used to gather evidence and are evaluated as a quite appropriate method to examine anthropological material and assess the internal structure of skeletal remains since they are non-destructive techniques.

Chronology of age-related disease definitions: osteoporosis and sarcopenia.

Low muscle mass at older age has been associated with functional impairments, cognitive decline and mortality. The term sarcopenia, coined in 1988, has been used interchangeably to describe low muscle mass, strength, and function. Without a well defined definition, results of studies using the term sarcopenia cannot be compared. Difficulties in defining sarcopenia parallel the history of defining osteoporosis. To understand critical steps that are needed to reach consensus in defining age-related diseases, we have identified milestones in the history of defining osteoporosis and compared these to sarcopenia. As a result, the main missing steps in the process of defining sarcopenia are: specific treatment options, pharmaceutical interest, and public awareness. Similar to osteoporosis being defined as 'low bone mineral density', the term sarcopenia should be reserved for 'low muscle mass'. Consensus must be reached regarding the diagnostic criteria to quantify muscle mass, correction factors, and reference populations used to define cut-off values of muscle mass.

[A history of the research on bone metabolism for the past 50 years in Japan and a memory of Dr. Hirotoshi Morii].

It has been 20 years since the monthly Journal "CLINICAL CALCIUM" was published in November, 1991. This review Journal edited by Drs. Hirotoshi Morii and Yoshio Yazaki has contributed a lot to the understanding of the importance of calcium in bone and cardiovascular systems. This article describes a history of the research on bone metabolism for the past 50 years in Japan. Also, a memory of my dear friend, Hirotoshi Morii, is retraced.

[Kanji character "sho" was first used for Japanese nomenclature of osteoporosis in 1897, the Meiji era].

The roughness and weakness of bone was really expressed by the character of "sho", which means the sight through the fine small leaves of pinetree in old Japabese seenery.