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Loder RT, Buzon MR, Sanders KE. A Healed Intertrochanteric Femur Fracture, Shoulder, and Rib Fractures in an Ancient Nubian Female: An Osteoarchaeological Perspective. ScientificWorldJournal 2024; 2024:8339694. [PMID: 38375132 PMCID: PMC10876308 DOI: 10.1155/2024/8339694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
This report is a case of a healed proximal intertrochanteric femur fracture nonunion in an ancient Nubian adult female, approximately 58 years old at the time of death, from the Tombos archaeological site in present day northern Sudan. Tombos was founded as an Egyptian colonial town during the New Kingdom Period (14001070 BC). The individual was radiocarbon dated to 1114-910 BC and also exhibited healed fractures of the left proximal humerus and ribs. There was shortening and mild atrophy of the right femur compared to the left; radiographs demonstrated a varus deformity of the proximal femur with associated retroversion. Bone density analysis revealed that the tissue mineral density z-score for this individual was -0.798, with the z-score for Tombos females 15-24 years old being 0.396, or a total difference of 1.194. This indicates that the individual was osteopenic but not osteoporotic prior to demise. This is an important case as it occurred approximately 3000 years ago and is the oldest known reported case of a healed intertrochanteric hip fracture in the archaeological literature. Archaeological cases of intertrochanteric hip fractures are rare, with none previously reported from the BC era. The timing of these multiple fractures is unknown, but all healed before the demise of the individual. Thus, there must have been considerable care afforded to such an individual to minimize the morbidities associated with nonoperative care of such a fracture. If all these fractures occurred at the same time due to a traumatic, accidental injury, the Modified Injury Severity Score (MISS) would be 25. Modern day trauma resuscitation and orthopaedic care gives an estimated mortality for such a MISS score of 28% for those <50 years old. It is likely that this individual's high socioeconomic status allowed for intensive nursing care which likely decreased the morality risk.
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Affiliation(s)
- Randall T. Loder
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michele R. Buzon
- Department of Anthropology, Purdue University, West Lafayette, IN, USA
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Pasini A, Rinaldo N, Bramanti B, Gualdi-Russo E. Technical note: Application and potentiality of quantitative ultrasonometry for the evaluation of bone mineral density status. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023; 181:140-154. [PMID: 36824053 DOI: 10.1002/ajpa.24711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/10/2023] [Accepted: 01/24/2023] [Indexed: 02/25/2023]
Abstract
The evaluation of bone mineral density (BMD) is an important task in paleopathology. Techniques commonly applied in bone quantity assessment, such as DXA or radiogrammetry (XR), suffer from several limitations when applied to skeletal remains. In recently published research, we developed a new methodology and new reference curves for the evaluation of BMD on human skeletal remains, applying for the first time Quantitative Ultrasonometry (QUS), a user-friendly, portable, and reliable clinical technique. This study aims to apply this new methodology to an archeological sample and to compare the results with those obtained through XR. We apply QUS and XR to a sample of 104 adults from Medieval Italian cemeteries. Fragility fractures were recorded. Descriptive statistics and comparisons between sexes, age-at-death cohorts, and individuals with and without fragility fractures were performed. Moreover, univariate and multivariate logistic regression models were used to define the parameters most predictive of fracture risk in past populations. The comparison between sexes showed no significant results concerning BMD parameters, whereas a decrease in BMD with increasing age is confirmed. The comparison between fracture and non-fracture individuals and the logit model demonstrated that QUS parameters, especially UBPI, are more reliable predictors of fracture risk in comparison to XR. Our results confirmed that QUS is a valuable technique that can be efficiently applied to archeological remains, also considering its portability. We also propose a modification of the previously published QUS standard curves, to easily assess osteopenia and osteoporosis in archeological material.
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Affiliation(s)
- Alba Pasini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Natascia Rinaldo
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Barbara Bramanti
- Department of Environmental and Prevention Sciences, University of Ferrara, Ferrara, Italy.,University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
| | - Emanuela Gualdi-Russo
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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van Spelde AM, Schroeder H, Kjellström A, Lidén K. Approaches to osteoporosis in paleopathology: How did methodology shape bone loss research? INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2021; 33:245-257. [PMID: 34044198 DOI: 10.1016/j.ijpp.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This paper will review how different methods employed to study bone loss in the past were used to explore different questions and aspects of bone loss, how methodology has changed over time, and how these different approaches have informed our understanding of bone loss in the past. MATERIALS AND METHODS A review and discussion is conducted on research protocols and results of 84 paleopathology publications on bone loss in archaeological skeletal collections published between 1969 and 2021. CONCLUSIONS The variety in research protocols confounds accurate meta-analysis of previously published research; however, more recent publications incorporate a combination of bone mass and bone quality based methods. Biased sample selection has resulted in a predominance of European and Medieval publications, limiting more general observations on bone loss in the past. Collection of dietary or paleopathological covariables is underemployed in the effort to interpret bone loss patterns. SIGNIFICANCE Paleopathology publications have demonstrated differences in bone loss between distinct archaeological populations, between sex and age groups, and have suggested factors underlying observed differences. However, a lack of a gold standard has encouraged the use of a wide range of methods. Understanding how this array of methods effects results is crucial in contextualizing our knowledge of bone loss in the past. LIMITATIONS The development of a research protocol is also influenced by available expertise, available equipment, restrictions imposed by the curator, and site-specific taphonomic aspects. These factors will likely continue to cause (minor) biases even if a best practice can be established. SUGGESTIONS FOR FUTURE RESEARCH Greater effort to develop uniform terminology and operational definitions of osteoporosis in skeletal remains, as well as the expansion of time scale and geographical areas studied. The Next-Generation Sequencing revolution has also opened up the possibility of ancient DNA analyses to study genetic predisposition to bone loss in the past.
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Affiliation(s)
- Anne-Marijn van Spelde
- Archaeological Research Laboratory, Department of Archaeology and Classical Studies, Stockholm University, Lilla Frescativägen 7, 114 18 Stockholm, Sweden; The Globe Institute, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark.
| | - Hannes Schroeder
- The Globe Institute, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark
| | - Anna Kjellström
- Osteological Research Laboratory, Department of Archaeology and Classical Studies, Stockholm University, Lilla Frescativägen 7, 114 18 Stockholm, Sweden
| | - Kerstin Lidén
- Archaeological Research Laboratory, Department of Archaeology and Classical Studies, Stockholm University, Lilla Frescativägen 7, 114 18 Stockholm, Sweden
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Kralick AE, Zemel BS. Evolutionary Perspectives on the Developing Skeleton and Implications for Lifelong Health. Front Endocrinol (Lausanne) 2020; 11:99. [PMID: 32194504 PMCID: PMC7064470 DOI: 10.3389/fendo.2020.00099] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/17/2020] [Indexed: 12/17/2022] Open
Abstract
Osteoporosis is a significant cause of morbidity and mortality in contemporary populations. This common disease of aging results from a state of bone fragility that occurs with low bone mass and loss of bone quality. Osteoporosis is thought to have origins in childhood. During growth and development, there are rapid gains in bone dimensions, mass, and strength. Peak bone mass is attained in young adulthood, well after the cessation of linear growth, and is a major determinant of osteoporosis later in life. Here we discuss the evolutionary implications of osteoporosis as a disease with developmental origins that is shaped by the interaction among genes, behavior, health status, and the environment during the attainment of peak bone mass. Studies of contemporary populations show that growth, body composition, sexual maturation, physical activity, nutritional status, and dietary intake are determinants of childhood bone accretion, and provide context for interpreting bone strength and osteoporosis in skeletal populations. Studies of skeletal populations demonstrate the role of subsistence strategies, social context, and occupation in the development of skeletal strength. Comparisons of contemporary living populations and archeological skeletal populations suggest declines in bone density and strength that have been occurring since the Pleistocene. Aspects of western lifestyles carry implications for optimal peak bone mass attainment and lifelong skeletal health, from increased longevity to circumstances during development such as obesity and sedentism. In light of these considerations, osteoporosis is a disease of contemporary human evolution and evolutionary perspectives provide a key lens for interpreting the changing global patterns of osteoporosis in human health.
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Affiliation(s)
- Alexandra E. Kralick
- Department of Anthropology, University of Pennsylvania, Philadelphia, PA, United States
| | - Babette S. Zemel
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- *Correspondence: Babette S. Zemel
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Mant M, de la Cova C, Ives R, Brickley MB. Perimortem fracture manifestations and mortality after hip fracture in a documented skeletal series. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2019; 27:56-65. [PMID: 31586732 DOI: 10.1016/j.ijpp.2019.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/03/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Unhealed hip fractures are underrepresented in the archaeological record, suggesting that better identification criteria are required. This paper evaluates whether a sample of documented perimortem hip fractures displayed classic perimortem features and which features may facilitate better identification of such fractures in the archaeological record. MATERIALS Ten individuals from the Robert J. Terry Anatomical Skeletal Collection with documented hip fractures and intervals of survival. METHODS We observed the skeletal remains macroscopically and with a Keyence VHX-2000 digital microscope at a range of 5x to 100x magnification. RESULTS 90% of the individuals and 64% of the fragments had identifiable perimortem features; hinging was the most consistent feature. Eburnation was found in two individuals who died 13 days after sustaining a hip fracture. CONCLUSIONS This study underscores the importance of examining fracture margins for evidence of hinging. Eburnation may be added to the list of potential perimortem fracture identification criteria. SIGNIFICANCE Identifying perimortem trauma unequivocally remains challenging. Using collections with documented perimortem fractures aids in determining which criteria are most likely to appear in archaeological human bone. LIMITATIONS The fracture location patterning (70% intertrochanteric) may be the result of sample selection. SUGGESTIONS FOR FUTURE RESEARCH Further intensive comparative investigation with the Hamann-Todd Collection would elucidate patterns further.
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Affiliation(s)
- Madeleine Mant
- Memorial University, Department of Archaeology, St. John's, Newfoundland and Labrador, A1B 3R6, Canada; McMaster University, Department of Anthropology, Hamilton, Ontario, L8S 4L9, Canada.
| | - Carlina de la Cova
- University of South Carolina, Department of Anthropology, Columbia, South Carolina, 29208, USA.
| | - Rachel Ives
- Natural History Museum, Department of Earth Sciences, Cromwell Road, SW7 5BD, London, United Kingdom.
| | - Megan B Brickley
- McMaster University, Department of Anthropology, Hamilton, Ontario, L8S 4L9, Canada.
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Antunes-Ferreira N, Prates C, Curate F. Extracapsular fracture of the femur in an elderly male from the Church of Nossa Senhora da Anunciada (Setúbal, Portugal). INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2018; 22:18-22. [PMID: 29627581 DOI: 10.1016/j.ijpp.2018.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 06/08/2023]
Abstract
In modern populations, hip fractures in older people are associated with high morbidity and mortality. Their incidence is rising; notwithstanding, fractures of the proximal femur are still relatively uncommon in archeological contexts. This case study represents a well-healed hip fracture in an aged male skeleton from Church of Nossa Senhora da Anunciada (16th-19th centuries AD) in Setúbal (Portugal). The individual was also diagnosed with diffuse idiopathic skeletal hyperostosis. Fractures of the proximal femur are usually associated with bone loss but in this case other causes are proposed, including the anatomy of the proximal femur, and the potential combined effect of diffuse idiopathic skeletal hyperostosis, cardiovascular disease, diabetes mellitus and falls.
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Affiliation(s)
- Nathalie Antunes-Ferreira
- CiiEM/IUEM, Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Monte da Caparica, Portugal; LCFPEM, Laboratório de Ciências Forenses e Psicológicas Egas Moniz, Egas Moniz Cooperativa de Ensino Superior, Monte da Caparica, Portugal; CRIA, Centro em Rede de Investigação em Antropologia, FCSH, Universidade NOVA de Lisboa, Lisboa, Portugal; LABOH, Laboratory of Biological Anthropology and Human Osteology, CRIA/FCSH, Lisboa, Portugal
| | - Carlos Prates
- IMI art, Imagens Médicas Integradas, Lisboa, Portugal
| | - Francisco Curate
- Research Centre for Anthropology and Health, Department of Life Sciences, University of Coimbra, Coimbra, Portugal; Laboratory of Forensic Anthropology, Department of Life Sciences, University of Coimbra, Coimbra, Portugal; Interdisciplinary Center for Archaeology and Evolution of Human Behaviour, University of Algarve, Faro, Portugal.
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Tucker K, Berezina N, Reinhold S, Kalmykov A, Belinskiy A, Gresky J. An accident at work? Traumatic lesions in the skeleton of a 4th millennium BCE "wagon driver" from Sharakhalsun, Russia. HOMO-JOURNAL OF COMPARATIVE HUMAN BIOLOGY 2017; 68:256-273. [PMID: 28615110 DOI: 10.1016/j.jchb.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
The study of ante-mortem trauma is a popular and important aspect of palaeopathological analysis. The majority of publications focus on a particular assemblage, skeletal element or type of fracture, with case studies of single individuals with multiple/unusual traumata being much rarer in the literature. This paper presents the case of an adult male from the Bronze Age site of Sharakhalsun, Russia, buried, uniquely, in a sitting position on a fully assembled wagon, who displayed evidence for multiple healed ante-mortem fractures of the cranium, axial and appendicular skeleton. The mechanisms and likely etiologies of the fractures are presented, with reference to modern and 19th century clinical literature, and possible interpretations suggested: that the individual was involved in a severe accident involving a wagon or draft animals, or both, a number of years before his death. The suggestion is also made that the unique burial position of the individual was a form of commemoration by the community of the survival and recovery of the individual from such a serious incident.
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Affiliation(s)
- K Tucker
- Department of Natural Sciences, German Archaeological Institute, 14195 Berlin, Germany.
| | - N Berezina
- Research Institute and Museum of Anthropology, Moscow State University, 123001 Moscow, Russia
| | - S Reinhold
- Eurasia Department, German Archaeological Institute, 14195 Berlin, Germany
| | | | | | - J Gresky
- Department of Natural Sciences, German Archaeological Institute, 14195 Berlin, Germany
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