The Bioarchaeology of Metabolic Bone Disease

Megan B. Brickley, Rachel Ives

• Publisher: Academic Press
• Year: 2010
• eBook ISBN: 9780080557915
• Topic: Social Sciences
• Subtopic: Orthopedics
• Index: Social Sciences

The Bioarchaeology of Metabolic Bone Disease provides a comprehensive and invaluable source of information on this important group of diseases. It is an essential guide for those engaged in either basic recording or in-depth research on human remains from archaeological sites. The range of potential tools for investigating metabolic diseases of bone are far greater than for many other conditions, and building on clinical investigations, this book will consider gross, surface features visible using microscopic examination, histological and radiological features of bone, that can be used to help investigate metabolic bone diseases. - Clear photographs and line drawings illustrate gross, histological and radiological features associated with each of the conditions - Covers a range of issues pertinent to the study of metabolic bone disease in archaeological skeletal material, including the problems that frequent co-existence of these conditions in individuals living in the past raises, the preservation of human bone and the impact this has on the ability to suggest a diagnosis of a condition - Includes a range of conditions that can lead to osteopenia and osteoporosis, including previous investigations of these conditions in archaeological bone

Chapter 1 Introduction

The impairment of health is of great importance in the modern world. Determining the extent to which disease also affected past populations is a fundamental goal of the study of bioarchaeology. The direct physical evidence derived from the examination of human remains provides a vital means of understanding illness and its impact on the lives of those who lived previously. In writing this book, we aim to develop the knowledge of past human health through a detailed consideration of factors that can mediate the expression of a particular group of diseases, the metabolic bone diseases.

This chapter introduces the specific nature of these complex and intriguing conditions, and highlights the insight they can provide into past life and health. We define the terminology crucial to the understanding of these diseases and outline the format that this book takes in illustrating the challenges faced in the reconstruction of health from many past contexts.

The scale of disease expression is vast and investigations of health in the past have expanded enormously over recent years (e.g. Cohen, 1989; Goodman et al., 1988; Goodman, 1993; Larsen, 1997; Ortner, 2003; Roberts and Cox, 2003; Buikstra and Beck, 2006). Specific study of the metabolic bone diseases provides a fascinating means of determining how factors inherent within a given lifestyle, including diet/nutrition, cultural practices, socio-economic status and environmental surrounding, can impact on health both at an individual and population level.

A significant focus of this research aims to highlight how an integrated appreciation of the metabolic bone diseases within many modern cultures can broaden the interpretative frameworks that are considered within bioarchaeology. Variation in disease expression may become manifest by additional factors involved in the onset and development of these conditions, including age, sex, ancestry and geographic habitat. Heritability can contribute to the development of various metabolic bone diseases, but interactions with many components of the environment may exacerbate or prevent disease expression. Recent research into the characteristics of these diseases in many modern populations, in addition to increasing investigation in zoological research, has significantly expanded the recognition and understanding of these conditions.

Many of the diseases examined in this book may be well known, such as osteoporosis; others are likely to be less so, including fluorosis. The spectrum of diseases that we discuss, demonstrate how the bioarchaeological evidence of human health can contribute to the overall study of anthropology. The distinctive goal of anthropology is a better understanding of humanity, whether it is the nature of social or cultural organisation and change, determining the role of human development in economic growth, or the adaptation to environmental situations and nutritional resources. Anthropology can be defined in a number of ways, but is used throughout this book to mean the study of all aspects of humankind, both past and present. Consideration of health challenges faced by non-human primates and other zoological species can also further our understanding of the diverse range of causative variables within a specific environment. Such observations are likely to make an important contribution to the interpretation of the many pathological conditions that can affect humans. The potential for consideration of metabolic bone disease manifestations in zoology will be highlighted through various avenues in this book.

METABOLIC BONE DISEASE: A DEFINITION

The term ‘metabolic bone disease’ has been used since 1948, when Albright and Reifenstein introduced it to describe conditions that affected the processes of bone formation and remodelling involving the whole skeleton (Albright and Reifenstein, 1948). As with many medical terms, subsequent alterations in the inherent meaning ascribed to this term have become apparent. Recently, there has been considerable interest in a group of cardiovascular diseases that pose significant health problems throughout the world. This group of closely related conditions has been termed the ‘metabolic syndrome’, and has become the focus of intense study (e.g. Byrne and Wild, 2006). Many of the conditions investigated in the present book could illuminate aspects of health and lifestyle that may impact on conditions within metabolic syndrome. However, our research does not detail obesity, high triglyceride levels, high blood pressure and low HDL (high-density lipoproteins)-cholesterol; conditions inherent within the metabolic syndrome (World Health Organization (WHO), 1999a).

In this book, the term metabolic bone disease is used to indicate conditions in which the processes of bone modelling and remodelling are specifically disrupted. These fundamental processes determining the structural organisation of the skeleton are discussed in Chapter 3. However, pathological changes may not systematically affect the whole skeleton. Particular conditions, such as Paget’s disease of bone (Chapter 8), tend to exhibit fairly localised skeletal changes rather than demonstrate involvement of the whole skeleton.

Various investigations have included anaemia as a manifestation of the metabolic bone diseases (e.g. Roberts and Manchester, 2005). This inclusion largely derives from the role of dietary iron deficiency in contributing to anaemia. The extensive involvement of bone marrow tissue in order to regenerate blood cell supply results in secondary effects on bone cells and structure. The specific diagnosis of iron deficiency anaemia in past populations is complex and likely over-estimated, particularly as the wide range of potential causative factors, which includes intestinal parasitic infections and/or excessive blood loss, are frequently overlooked. The diagnosis of the condition can be challenging and cannot be simply attributed to cortical bone porosity in the skull, most notably the orbits (cribra orbitalia). As such, anaemia has not been considered as a specific example of the metabolic bone diseases in this book. However, the secondary effects of this condition can result in the development of various other metabolic conditions, including vitamin C deficiency and osteopenia, and it will be discussed where relevant to these conditions (Chapters 4 and 7, respectively).

FORMAT OF THE BOOK

The discussions throughout this book aim to demonstrate the important role that the analysis of metabolic bone disease has in developing a comprehensive understanding of health, particularly as an indicator of life within past populations. The study of paleopathology is vital in advancing the knowledge of health in the past. However, it is critical that such work should not be viewed as an end in itself, but rather as a step in a wider process enabling increasingly accurate interpretations of health in the past to be ascertained. As has been emphasised above, consideration of manifestations of metabolic bone disease and health within various modern contexts will develop the interpretative framework to which paleopathology substantially contributes. Chapter 2 introduces the study of metabolic disease in bioarchaeology and highlights the benefits and challenges of the evidence and methods that are available to enable investigation of these diseases in the past. Consideration is also given to using clinical data in bioarchaeological research and the potential benefits and pitfalls of this type of information. This chapter further outlines the wider relationship that bioarchaeological research can have in investigations within the many sub-disciplines of anthropology.

Accurate interpretations of the metabolic bone diseases are enhanced by recognition of the normal and pathological processes evident at the bone cell level. Chapter 3 presents an introduction to bone biology with a review of the mechanisms inherent in bone growth (modelling) and maintenance (remodelling), as well as the functions of individual cells and the systemic and local factors that can influence cell behaviour. Recent years have seen a number of important advances in the understanding of bone structures and processes. Continued awareness of these advances made in clinical and scientific research has important consequences for those working within bioarchaeology. As such, this chapter contains references to recent investigations at the bone cell level to create a basis for more detailed consideration of this subject.

The subsequent chapters of this book each discuss a specific metabolic bone disease, considering the nature of the disease process and etiology. Within each chapter an emphasis is placed on the modern understanding of the disease, together with extensive discussion of prominent anthropological considerations and debates. The existing archaeological evidence for each disease is reviewed, together with recommendations for directions of future developments necessary for improving current knowledge. Each chapter concludes with the macroscopic, radiological and histological features that are required for the paleopathological diagnosis of these conditions.

The chapters contain a series of Box Features designed to illustrate how the analysis of the metabolic bone diseases can provide a range of insights into issues considered by many anthropologists. Variation in health can have widespread impacts in nutritional, cultural, social and biological/physical anthropology. The Box Features aim to explore a range of key concepts which could be investigated by considering disease interactions, modern versus past perspectives or animal versus human disease expression, in order to enhance the study of anthropology.

Discussion of vitamin C deficiency (scurvy) in Chapter 4 demonstrates the potential for this disease to become manifest across very diverse contexts. Recent advances in paleopathological diagnosis have demonstrated that scurvy cannot be considered merely as a disease of mariners, or as a simplistic consequence of warfare. The etiologies of many of the metabolic bone diseases are complex, enabling them to exist in a wide range of situations, as well as in non-human primates. Chapter 5 discusses the nature of vitamin D deficiency and its manifestation in children and adults. This chapter illustrates how various metabolic bone diseases can provide substantial data on the range of factors, including living conditions, pollution levels, cultural practices and nutritional quality, that can have a detrimental impact on health.

Osteopenia, or abnormal bone loss, has recently attracted considerable interest in modern medicine. Chapter 6 investigates the age-related onset of osteoporosis, a condition that has a very prominent place in relation to women, in both clinical and mass media. This chapter tackles the wider issues related to the onset of this condition including its expression in males and considers to what extent variation in the causative factors may alter the timing and prevalence of this disease in different societies. Whilst humans appear to have always suffered from bone loss as they age, bioarchaeological evidence from around the world indicates the inherent variations in rates of bone loss between different population groups, with implications for the onset and identification of pathological outcomes. Chapter 7 considers the wider range of circumstances that can result in osteopenia as a secondary pathological consequence. Loss of reliable food resources and the complex outcomes of dietary interactions are considered, together with the effects of limited treatments previously available for a number of conditions, as significant factors likely to have contributed to secondary osteopenia in many past populations.

Chapter 8 explores the nature of Paget’s disease of bone. This is a particularly important condition to consider, as despite investigations spanning over 100 years, there is still no known cause for this disease. Whilst presently limiting potential bioarchaeological interpretations, it does provide an exciting opportunity for accumulating paleopathological evidence to substantially enhance what is currently known of the causative mechanisms. A number of lesser known metabolic bone diseases are evaluated in Chapter 9, such as fluorosis and pellagra. With further investigation the understanding and identification of these conditions in past societies can make central developments to the study of health.

The final chapter of the book, Chapter 10, draws together an overview of the principal components of the findings and concepts within this research. This chapter provides a reference for those who wish to discover the fields in which future research on these subjects might most fruitfully be directed. Ultimately, the range of information brought together in this book aims to demonstrate that the metabolic bone diseases have an increasingly important role to play in bioarchaeology, through enabling many anthropologists to gain a fuller understanding of health and its complex interaction in past human life.

Chapter 2 The Study of Metabolic Bone Disease in Bioarchaeology

The study of metabolic bone disease has an important role to play in improving the understanding of a variety of aspects of life i...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Acknowledgements
• Foreword
• Chapter 1: Introduction
• Chapter 2: The Study of Metabolic Bone Disease in Bioarchaeology
• Chapter 3: Background to Bone Biology and Mineral Metabolism
• Chapter 4: Vitamin C Deficiency Scurvy
• Chapter 5: Vitamin D Deficiency
• Chapter 6: Age-Related Bone Loss and Osteoporosis
• Chapter 7: Secondary Osteopenia and Osteoporosis
• Chapter 8: Paget’s Disease of Bone
• Chapter 9: Miscellaneous Conditions
• Chapter 10: Overview and Directions for Future Research
• Bibliography
• Index