Skeletal manifestations of metabolic diseases are caused by pathologic processes that
affect the development and maintenance of normal bone as well as associated tissues such as tendons and
ligaments. There is some ambiguity about the specific diseases that are appropriate to include in this
category. However, most biomedical researchers agree that scurvy, rickets and osteoporosis qualify.
Many of the metabolic diseases are the result of too much or too little of some dietary component.
However some, such as osteoporosis, may be the result of dietary deficiency but more commonly have an
important endocrine abnormality in the pathogenesis.
Evidence of metabolic diseases in antiquity exists but publications on the subject are
uncommon (Ortner 2003). Recent research that I have conducted on both scurvy and rickets in
archeological skeletal samples suggests that part of the reason for this is that the pattern of skeletal
manifestations emphasized in the clinical literature is somewhat different from the evidence of these
diseases seen in ancient remains (Ortner et al. 1999; Ortner et al. 2001). In childhood scurvy, for
example, the most common lesions on the skull are associated with bone linked to muscles of mastication
and not the skull vault (Ortner and Erickson 1997). However, the limited number of reports on rickets is
probably due to the fact that at least the skeletal manifestations of the disease and perhaps the disease
itself was uncommon in populations from which most archeological skeletal samples are drawn (Ortner and
Mays 1998).
Iron deficiency anemia is a disease caused by a deficiency in the availability of iron for
red blood cell formation. This disease is usually classified with the hematopoietic diseases along with
the anemias caused by a genetic defect in hemoglobin synthesis. When anemia affects the skeleton it does
so through an abnormal enlargement of hematopoietic marrow at the expense of compact bone. In the skull
this enlargement results in greatly increased the diploë and, typically, produces a porous outer table.
In archeological human remains, the skull abnormalities seen in anemia can be, and probably have been,
confused with those seen in scurvy and perhaps rickets (Ortner 2003). During my presentation I will
review the skeletal changes seen in some of the metabolic diseases and highlight how these can be
distinguished from those caused by anemia.
References
- Ortner, D. J. and M. F. Ericksen 1997. Bone Changes in the human skull probably resulting from
scurvy in infancy and childhood. International Journal of Osteoarchaeology 7:212-220.
- Ortner, D.J. and S. Mays 1998. Dry-Bone Manifestations of Rickets in Infancy and Early Childhood.
International Journal of Osteoarchaeology 8: 45-55.
- Ortner, D.J., E. Kimmerle, and M. Diez 1999. Skeletal evidence of scurvy in archeological skeletal
samples from Peru. American Journal of Physical Anthropology, 108: 321-331.
- Ortner, D. J., W. Butler, J. Cafarella, and L. Milligan 2001 Evidence of probable scurvy in subadults
from archeological sites in North America. American Journal of Physical Anthropology 11:343-351.
- Ortner, D. J. 2003 Identification of Pathological Conditions in Human Skeletal Remains, second
edition. Amsterdam: Academic Press.
