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ABSTRACT Background Methods Results Discussion and Conclusions In prior exploration of modern and archeological populations, lower SES has been associated with an increased risk of mortality. However, SES is often difficult to ascertain in archeological populations. Thus, explorations of skeletal lesions and their association with mortality may be subject to confounding factors that alter the strength and/or direction of this association.The present study uses data from a modern, documented coronial pediatric dataset to examine the association between porous cranial lesions (PCLs) (cribra orbitalia [CO] and porotic hyperostosis [PH]) and age at death while controlling for SES, as inferred through housing type, with manufactured or apartment housing identified as reflecting individuals from lower SES backgrounds in this context. We include 887 (535 males, 352 females) individuals aged 0.5–20.9 years from New Mexico who died between 2011 and 2022. Kaplan–Meier survival analysis was used to assess survivorship as related to PCLs and SES.Low SES is associated with lower survivorship. CO does not have a significant association with age at death when not controlling for SES; PH alone is associated with older age at death. Disadvantaged individuals with PCLs have significantly reduced survivorship than those with higher SES.The findings of this study demonstrate that low SES results in reduced survivorship, and those with low SES and PCLs have worse survivorship than less disadvantaged individuals with PCLs. Thus, the strong contribution of SES to mortality necessitates the consideration of the sociocultural context as a confounding factor when examining associations between variables of interest (such as lesions) and mortality in both past and present populations. [ABSTRACT FROM AUTHOR]

Biological anthropologists frequently explore skeletal asymmetry, together with population health and disease. Given the conflicting findings in existing literature, this study aimed to clarify whether an association exists in a South African sample. Dry bone and cranial micro-focus X-ray Computed Tomography (micro-XCT) scans of 115 South African individuals were assessed. Fluctuating asymmetry (FA) indices were calculated from interlandmark distances, and the frequency of four types of non-specific signs of physiological stress were documented to explore the relationship between FA and disease. Black South Africans did not exhibit a high FA index; however, they had the highest prevalence of non-specific signs of physiological stress. However, no significant correlations were detected between FA indices and pathological lesions. No correlation was observed between FA and populations from different socio-economic backgrounds. However, individuals of lower socio-economic status (SES) demonstrated a greater prevalence of non-specific signs of physiological stress. This research suggests that skeletal indicators of stress may be a suitable biological marker for assessing differences in SES among population groups, while indicating that levels of cranial FA is an inadequate biological marker. Possible limitations may include measurement error, and the lack of information on the life history and medical records of individuals in this sample. Future research should include a larger sample with more South African groups, and should evaluate the potential association among age, FA, and expression of skeletal markers of disease. [ABSTRACT FROM AUTHOR]

This paper reviews factors confounding the understanding of the past occurrence of anemia. Using the evidence gathered, a framework is presented of ways forward to enable greater confidence in diagnosing acquired anemia in paleopathology, facilitating insights into longer-term perspectives on this globally relevant condition. To date, porotic lesions have been central to paleopathological investigations of anemia. The fact that porotic bone lesions are omnipresent and have multiple causes but are likely to have a relatively low, age-related frequency in individuals with anemia, a condition that will have been common in past communities, is confounding. Establishing frameworks that move away from porotic lesions is proposed to facilitate higher levels of more accurate anemia diagnoses in paleopathology. Acceptance of the fundamental principle that anemia may be better considered as a condition requiring metric evaluation of bone structures, supplemented by careful consideration of lesions, will advance understanding of acquired anemia in past communities. Such an approach would provide a clear basis for further consideration of congenital conditions causing anemia, such as sickle-cell disease and thalassemia. This paper simply opens the conversation on the better diagnosis of anemia in paleopathology; it starts the iterative process of achieving some consensus and progress on diagnosing anemia in paleopathology. Engagement with ideas presented, sharing data and development of metric parameters will assist in identifying the effects of marrow hyperplasia on bone, enabling more robust work on the important topic of anemia. [ABSTRACT FROM AUTHOR]

This paper presents the results of a 2019 Paleopathology Association workshop that tested observer agreement on porous cranial lesion morphology and presence using multiple sets of existing guidelines for data collection. Sixteen conference attendees of varying osteological experience served as observers. Three crania were assigned to each of four published guidelines for identifying and categorizing lesion morphology, for a total of twelve well-preserved human crania from the National Museum of Natural History Biological Anthropology Collections. Observers assessed each cranium macroscopically according to its assigned set of guidelines. Observer concordance was higher using scoring guidelines with higher-quality photographs, such as the 2019 guidelines from Rinaldo and colleagues. Data collection guidelines with high-quality color photos may support greater reliability of researcher-generated data on macroscopic skeletal features. The conclusions of any research study are only as reliable as the data on which they are based. This work highlights the need for ongoing practices of quality control in a field in which much data results from individual judgement calls. Observer concordance is not a measure of observer accuracy. Sample size is insufficient to draw broadly generalizable conclusions on the reliability of data collected using the guidelines tested, and conference environments are not a facsimile of research settings. Iterative testing of methodological consistency using larger sample sizes and more non-pathological crania is advised to identify the factors that influence observer discordance and to improve guidelines for qualitative assessments. [ABSTRACT FROM AUTHOR]

Background: Linear enamel hypoplasia (LEH) and porous cranial lesions such as cribra orbitalia (CO) and porotic hyperostosis (PH) are considered nonspecific indicators of early childhood metabolic stress. Objectives: The study aims to describe the association of LEH with CO and PH in a sample of the Kirsten Skeletal Collection (KSC) rep- resenting a cohort in the Western Cape, South Africa. This will be used to determine if one or more of these lesions can be used as an indicator of adult mortality. Sample and Methods: Skulls (n = 412) of both sexes with known demo- graphics from the KSC were macroscopically scored for LEH, CO and PH lesions using a ring light. This study was ethically approved by the Health Research and Ethics Committee of Stellenbosch Uni- versity (S13/05/100).Statistical chi-square tests were used to deter- mine the association between lesions and student’s t-tests to deter- mine if there was a significant difference in mean age-of-death be- tween groups. Results: There was no association when comparing LEH with CO and PH in the cohort, although an association was found between CO and PH. Individuals who exhibited the pathological lesions for LEH, CO or PH (or a combination thereof) were observed to have a younger mean age-at-death than the individuals without any of the three disease lesions. Conclusions: The lesions may potentially be used as an indicator of adult mortality. However, the results of this study might represent a biased population of low socio-economic status in the Western Cape as represented in the KSC, rather than the general population of the region.

We explore health and stress in the urban metropolis Nea Paphos (Cyprus) and its surrounding territory during the Hellenistic (312–58 BC) and Roman (58 BC to 395 AD) periods, through a bioarchaeological study. Data were acquired from macroscopic analyses of human remains from two necropoleis in Paphos district: the Eastern Necropolis of Nea Paphos (minimum number of individuals = 165) and the necropolis of Ktima‐Upper City (minimum number of individuals = 207). Data have been acquired from adult/nonadult and male/female individuals through analysis of specific health indicators. These are porotic hyperostosis (PH), cribra orbitalia (CO), and linear enamel hypoplasia. Overall, health indicators were recorded in low to moderate frequencies in both sites. Ktima‐Upper City showed higher frequency of linear enamel hypoplasia (31.8%) compared with Nea Paphos (9.4%), while PH and CO were more prevalent within Eastern Necropolis (CO: 31.3% vs 8% and PH: 29.2% vs 13.9%) suggesting that people living in the capital were more exposed to factors causing CO and PH, during childhood. Intrasite analysis showed differences between the two sexes and the occurrence of health stressors. These factors are likely linked with social, cultural, and dietary differences, subsequently reflecting a larger and more heterogeneous population within and between the two sites. The findings suggest that there are differences between urban Nea Paphos and Ktima‐Upper City. These differences are not major yet indicating some division between the two groups. This study is one of the first to investigate urbanism and health in ancient Cyprus, with focus on the Hellenistic–Roman periods. The comparison of the two sites provides new insights into the health of Hellenistic–Roman Cypriot populations, enabling future investigation and comparison between urban–rural regional and neighboring sites. [ABSTRACT FROM AUTHOR]

Simple Summary: Although violence is generally understood in its direct form (as physical violence), this is not its only manifestation. Indirect or structural violence results from unequal access to resources and leads to poor quality of health, which may be visible on skeletal remains through various markers. In this paper, three of these markers which may reflect structural violence were examined on skeletal samples of migrants who died during the crossing of the Mediterranean Sea and Italian-born individuals from the CAL Milano Cemetery Skeletal Collection. Results showed that these stress markers were more common and more severe among migrants than non-migrants. The analysis and recognition of such markers in forensic contexts can improve the biological profile by considering the biological effects of cultural, political, and social living conditions. Structural violence is an indirect form of violence that can lead to physiological consequences. Interestingly, these physiological disruptions may affect the skeletons and can therefore provide relevant information on violence and way of life in the analysis of skeletal remains. The aim of the present study was to test the hypothesis that migrants who died in the Mediterranean Sea would present physiological cranial stress markers such as cribra orbitalia (CO), porotic hyperostosis (PH), and linear enamel hypoplasia (LEH) more frequently and more severely than Italians of the 20th century. With this intent, a total of 164 crania were examined: 139 from deceased migrants recovered from a shipwreck in the Mediterranean Sea in 2015, aged between 16 and 35 years old, and 25 of the same age from the CAL Milano Cemetery Skeletal Collection. Both presence and severity of CO, PH, and LEH were evaluated. The data obtained were analyzed using Wilcoxon signed-rank and independence Chi-squared tests to compare the results between the two samples and to test whether there was an association between the sample of migrants and the occurrence of lesions. As a result, CO and PH appeared more frequently and more severely in the migrant sample. In addition, migrants were significantly associated with CO, PH, and LEH (p-values < 0.05). Although this does not imply in any way that CO, PH, and LEH are specific to migration, they should be regarded as indicators of structural violence. [ABSTRACT FROM AUTHOR]

Introduction: Adverse experiences leading to physiological disruptions (stress) in early life produce cascade effects on various biological systems, including the endocrine and metabolic systems, which, in turn, shape the developing skeletal system. To evaluate the effects of stress on adipose and skeletal tissues, we examine the relationship between skeletal indicators of stress (porotic hyperostosis [PH] and cribra orbitalia [CO]), bone mineral density (BMD), vertebral neural canal (VNC) diameters, and adipose tissue distribution in a contemporary pediatric autopsy sample., Methods: Data is from 702 (409 males, 293 females) individuals from a pediatric (0.5-20.9 years) autopsy sample from New Mexico who died between 2011 and 2022. Data includes visceral adipose tissue (VAT) in the abdomen, heart, and liver, CO/PH, VNC size of the fifth lumbar vertebra, and BMD., Results: We find that adipose tissue distribution and location are differentially associated with CO/PH, BMD, and VNC size; VNC size is smaller, and liver adiposity is higher in those with CO/PH. Further, increased VAT and small VNC size are associated with PH presence and low BMD. Body mass index categories do not correspond with porous cranial lesion presence., Conclusions: This paper provides evidence for the complex relationship between skeletal markers of early-life stress (CO/PH, reduced VNC size, low BMD) and endocrine system function. VAT distribution and VNC size are partly shaped by stressors during gestation, likely through alterations of the HPA axis. It is possible that alterations of the HPA axis due to gestational stress also shape the expression of porous cranial lesions during exposure to childhood stressors., (© 2025 Wiley Periodicals LLC.)

During the Bronze Age (BA; ca. 1800–500 BC), cremation became the dominant burial practice in Finland. These BA cremations have been excavated from burial cairns in Finland for more than 150 years. This work provides new information on human osteology from this previously understudied area in northeastern Europe. The results cover the earliest period in Finnish prehistory for which large‐scale human osteological assemblages are available. In this article, we present a comprehensive human osteological study on the curated bone collections of the National Museum of Finland and other provincial museums and provide new radiocarbon datings of the cairns. The results show that the cairns were most often used for single burials, without accompanying animals or artifacts. Double and multiple burials became more common in the Iron Age. Porotic hyperostosis was a common finding. Signs of osteoarthritis are more common in the central Satakunta region, where Iron Age burial practices first emerged already during the Late BA. These observed changes can be connected to changes in subsistence strategies that also enabled permanent settlements. [ABSTRACT FROM AUTHOR]

This paper represents an attempt to conduct a bioarchaeological study of the anthropological materials of the Late Sarmatian period from burials of the late 3rd — 4th c. AD in the Lower Volga Region. The examined group consisted of osteological remains of 24 individuals. The standard assessment program of skeletal pathological conditions and univariate and multivariate statistics methods were applied. The study has shown that the series from the late 3rd — 4th c. AD nomadic burials of the Lower Volga Region is generally compatible with the Sarma-tian group of the late 2nd — early 3rd c. AD and that of the late Sarmatian time. Yet, there are identifiable differ-ences in the late group, which must be related to negative factors associated with the environmental changes during that period.

Objectives: In previous work examining the etiology of cribra orbitalia (CO) and porotic hyperostosis (PH) in a contemporary juvenile mortality sample, we noted that males had higher odds of having CO lesions than females. Here, we examine potential reasons for this pattern in greater detail. Four non‐mutually exclusive mechanisms could explain the observed sex differences: (1) sex‐biased mortality; (2) sexual dimorphism in immune responses; (3) sexual dimorphism in bone turnover; or (4) sexual dimorphism in marrow conversion. Subjects and methods: The sample consists of postmortem computed tomography scans and autopsy reports, field reports, and limited medical records of 488 individuals from New Mexico (203 females; 285 males) aged between 0.5 and 15 years. We used Kaplan–Meier survival analysis, predicted probabilities, and odds ratios to test each mechanism. Results: Males do not have lower survival probabilities than females, and we find no indications of sex differences in immune response. Overall, males have a higher probability of having CO or PH lesions than females. Conclusions: All results indicate that lesion formation in juveniles is influenced by some combination of sex differences in the pace of red–yellow conversion of the bone marrow and bone turnover. The preponderance of males with CO and PH likely speaks to the potential for heightened osteoblastic activity in males. We find no support for the hypotheses that sex biases in mortality or immune responses impacted lesion frequency in this sample. Sex differences in biological processes experienced by children may affect lesion formation and lesion expression in later life. [ABSTRACT FROM AUTHOR]

Background: The reliability of a recent review of meningiomas in the archeologic record was difficult to assess, given the inverted sex ratio of the report and other contents apparently at variance with anatomical/medical findings in scientifically identified cases. It therefore seemed appropriate to reexamine the nature of meningiomas and derive improve criteria for their recognition in the archeologic record and distinguish them from hemangiomas and bone marrow hyperplasia (recognized in the form of porotic hyperostosis). Methods: Medically documented cases of meningiomas were examined to establish a macroscopic standard distinguishing them. Alleged cases in the archeologic record were examined for conformity with those criteria. Results: An en face pattern of uniform mesh with contained whorls appears pathognomonic for meningiomas. This contrasts with the non-uniform marrow expansion displacement of trabeculae in porotic hyperostosis and non-uniform vascular displacement of trabeculae in hemangiomas. Reassessment of past attributions revealed few cases of meningiomas that could be confidently diagnosed. Those identified have sex ratios parsimonious with medical literature reports. Conclusions: Criteria suggested for identifying meningiomas permit distinguishing from hemangiomas, bone marrow hyperplasia (porotic hyperostosis) and from the macroscopically observable surface spicules characteristic of osteosarcomas. Examination for fulfillment of criteria for meningiomas and hemangiomas seems to provide a picture (including sex ratios) mirroring that of the clinical literature, concluding that Cook and Danforth's disparate ratios were related to less fastidious case selection. Additionally, confidence in recognizing porotic hyperostosis may be compromised because of apparent similar macroscopic alterations to those seen with hemangiomas. [ABSTRACT FROM AUTHOR]

Background One of the most studied pathological conditions in human bone remains is porotic hyperostosis and cribra orbitalia, where the condition of porosity or bone tissue is porous and looks like a coral, sieve or sponge-like formation, and is often associated with a history of anemia. nutritional deficiencies, certain diseases and so on. This is often seen in the skull because the bone tries to increase the marrow space available for increased red blood cell formation. Porotic hyperostosis and cribra orbitalia (some paleopathologists put into the same category as porotic hyperostosis) occur due to conditions caused by the body's attempts to produce more red blood cells in the marrow to compensate for iron deficiency. The longer this iron deficiency continues, the more clearly these lesions will form. Objective This study was conducted to see the picture of the lesion porotic hyperostosis and criba orbitalia associated with anemia and nutritional deficiencies. Methods This study is a case study by observing an intact skull without a mandible, by inspecting the regions of the skull and the roof of the orbit. Results Found coral, sieve or spongy formations on the roof of the skull and the roof of the orbit. The presence of a skull lesion can be an indicator of the fragility of an individual's bones. Conclusion Anemia and deficiency conditions can result in the formation of lesions in the skull. [ABSTRACT FROM AUTHOR]

While much is known about the rise and expansion of the Inca Empire (AD 1438–1532) throughout the Andean region of South America, the health effects of the empire in its capital region remain unclear. The present study addresses the Inca Empire's impact on health in the Cuzco region of Peru through an analysis of four conditions (dental enamel hypoplasias, cribra orbitalia, porotic hyperostosis and periosteal lesions) in 929 pre‐Inca and Inca burials. The study results show little change in health from the Late Intermediate Period (AD 1000–1438) to the Inca Imperial Period (AD 1438–1532). When the location of the Inca burial sites was analysed, individuals from sites closest to the centre of the empire's capital showed lower frequencies in pathological conditions compared with individuals from sites in the countryside. These results suggest that individuals centred in the Inca imperial sphere benefited from their position and experienced better health. A similar finding was also seen with the previous Wari occupation of Cuzco in the Middle Horizon (AD 600–1000), as burials within the Wari imperial sphere exhibited fewer non‐specific stress indicators than those outside of it. Overall, the frequencies of pathological conditions in the Cuzco region, which ranged from 4.6% for porotic hyperostosis to 18.8% for periosteal lesions, were lower than frequencies from many coastal Peruvian sites. These differences may relate to a diverse diet provided by the Cuzco region ecosystem, as well as the absence of ecological challenges that affected coastal populations. [ABSTRACT FROM AUTHOR]

Porotic hyperostosis (PH) is the expansion of the cranial diploë, generating ‘hair-on-end’ appearance on X-rays. This condition is extremely rare and had a prevalence of 0.08%. It is alternatively known as cribra orbitalia (CO) when the orbital roof is affected. In this study, we describe the gross morphology of two skulls affected by PH and CO. The first skull belonged to a 41-year-old female previously diagnosed with beta thalassemia. The skull was affected by excessive PH and CO. The second skull, belonging to a 35-year-old male diagnosed with unspecified thalassemia, showed PH without CO. The etiology of PH and CO is discussed. In conclusion, PH and CO are extremely rare, and are of significant importance for radiologists and anatomists when interpreting radiographs or encountering unusual gross morphology of the skull. [ABSTRACT FROM AUTHOR]

The cribra orbitalia or porotic hyperostosis of the orbital roof is considered a microperforative bone manifestation of hematological pathological conditions, especially iron deficiency anemia. This finding is almost exclusively part of studies in archaeological populations. The purpose of this study was to describe the expression of cribra orbitalia in an archaeological population of central Chile. Bone remains of 32 individuals were analyzed, which were obtained from the population of the Tutuquén Cemetery Archaeological Monument, which are deposited in the Regional Museum of Rancagua. In each of the included samples, dating periods, sex, age range, presence v / s absence of cribra orbitalia were evaluated and in the cases in which it was present, its intensity was determined by direct vision with a magnifying lens. The 59.38 % of the individuals presented cribra orbitalia. Of these, 26.32 % were female, 31.58 % male, and 42.10 % undetermined. Of the individuals in the period 10,000 BP, 33.33 % presented cribra orbitalia; of the individuals of the period 7,000 AP, 50 % and of the individuals belonging to the period 1,000 AP, 68.4 %. When classifying the severity of the cribra orbitalia, it was observed that 31.57 % of the individuals had type I; 36.84 % type II; 10.52 % type III; 10.52 % type IV and 10.52 % type V. The data provided will complement the morpho-pathological knowledge of the human eye orbit from the study of archaeological populations. [ABSTRACT FROM AUTHOR]

The current study evaluates the feasibility of using clinical cranial computed tomography (CT) scans for assessing the presence and morphology of porous cranial lesions (cribra orbitalia, porotic hyperostosis). Observers (n = 4) conducted three independent evaluations of porous cranial lesions based on photographs, 2-D CT, and 3-D CT scans of archaeological crania. Evaluations of the crania from each viewing scenario were compared to findings from direct macroscopic observation. Twenty-two complete adult crania from the Peruvian sites of Pachacamac and Chicama. We found that lesion visibility differed by location: vault lesions with porosity larger than the resolution of the CT scan were identifiable across all viewing scenarios, but orbital lesions were identifiable only when extensive porosity was accompanied by widening of the inter-trabecular spaces. Lesions in stages of advanced remodeling were not visible on CT. Paleopathological criteria applied to head CTs from clinical cases of suspected cranial fracture can reliably identify moderate to severe porous cranial lesions in living individuals. This validation study opens the door to broader study of porous cranial lesions in living individuals that can address open questions about the causes and consequences of these commonly reported skeletal indicators of stress. Performance of all viewing scenarios was evaluated relative to assessment data from direct observation of skeletal remains, but direct observation is itself subject to error. The increasing resolution of routine CTs makes it increasingly possible to explore skeletal lesions in clinical contexts. [ABSTRACT FROM AUTHOR]

Objectives: Cribra orbitalia (CO) and porotic hyperostosis (PH) are porous cranial lesions (PCLs) classically associated with iron‐deficiency anemia in bioarchaeological contexts. However, recent studies indicate a need to reassess the interpretation of PCLs. This study addresses the potential health correlates of PCLs in a contemporary sample by examining relationships between the known cause of death (COD) and PCL presence/absence. Methods: This study includes a sample of 461 juvenile individuals (6 months to 15 years of age) who underwent examination at the University of New Mexico's Office of the Medical Investigator between 2011 and 2019. The information available for each individual includes their sex, age at death, and their COD and manner of death. Results: Odds ratio of having CO (OR = 3.92, p <.01) or PH (OR = 2.86, p =.02) lesions are increased in individuals with respiratory infections. Individuals with heart conditions have increased odds of having CO (OR = 3.52, p =.03) lesions, but not PH. Conclusion: Individuals with respiratory infection are more likely to have CO and/or PH. CO appears to have a greater range of health correlates than PH does, as indicated by the heart condition results. However, individuals with congenital heart defects are at higher risk for respiratory infections, so bony alterations in cases of heart conditions may be due to respiratory illness. Since respiratory infection remains a leading cause of mortality today, CO and PH in bioarchaeological contexts should be considered as potential indicators of respiratory infections in the past. [ABSTRACT FROM AUTHOR]

After emancipation, most African Americans remained tethered to agricultural economies, while others migrated to cities seeking better opportunities. Although bioarchaeologists have made significant interventions in researching people of African descent, there are relatively few published comparative studies that address their morbidity and mortality after slavery. This study compares the bioarchaeological evidence for rural and urban southern United States populations to address disparities in health and longevity. It considers the biological effects of racism, including the health impacts of poverty, disease, and malnourishment. Although historians and demographers argue that urban life was especially detrimental to health, the results of this research suggest greater complexity in African American well-being. Whereas urban adults had higher midlife mortality and reduced longevity compared to their rural counterparts, both rural and urban children experienced poor health. Rural child mortality and morbidity varied significantly, suggesting differences in diet and disease exposure across rural communities. With regard to gender, rural and urban women died at younger ages than men. This disparity in mortality is partly attributed to black women's working and reproductive lives within the context of racism and gender inequality. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: Physiological disturbances in early life have been shown to increase individual mortality risk and impact health in adulthood. This study examines frailty through analysis of lesion status of two commonly collected skeletal indicators of stress (cribra orbitalia [CO] and porotic hyperostosis [PH]) and their association with mortality risk in the precontact U.S. Southwest. Several predictions are addressed: (a) individuals with active skeletal lesions are the frailest; (b) individuals with healed lesions are the least frail; (c) CO lesions, regardless of status, are associated with increased mortality risk. Materials and methods: Odds ratios and Kaplan–Meier survival analysis are used to examine the association between stress indicators and mortality in the U.S. Southwest. This study includes 335 individuals (75 females, 81 males, 20 adults of unknown sex, and 159 juveniles) from precontact New Mexico archaeological sites dating to A.D. 1,000–1,400. Results: Active CO and PH lesions are associated with lower survivorship and greater mortality risk than healed or absent lesions. Only juvenile individuals have active CO and PH lesions, as is expected given their physiology. CO lesions in any state are associated with greater mortality risk and earlier ages of death. Discussion: Individuals with active lesions are the frailest; while individuals with healed lesions are the least frail. CO and PH likely have different etiologies: CO lesions are associated with increased mortality risk and decreased individual longevity. These results indicate that CO's presence suggests a more severe underlying condition than PH lesions alone. [ABSTRACT FROM AUTHOR]

The Little Ice Age, beginning in Europe in the 14th century, saw a period of climatic cooling and increased precipitation where food sources dwindled and famine became rampant, particularly in urban city centers. This study focuses on the Black Friars population (13th-17th centuries) to explore changes in stress in Denmark at the onset of the Little Ice Age. This study specifically explores the periods before and after the turn of the 14th century. Forty-five adult individuals were analyzed for cribra orbitalia, porotic hyperostosis, and enamel hypoplastic lesions. Results showed no statistically significant differences between the prevalence of these stress indicators between either time period; however, reduced age at death and increased lesion frequency was more prevalent post-1300. It was expected that increased stress would be evident in those buried after the turn of the 14th century due to the many challenges associated with wide spread climatic cooling; however, the reliance on nutrient rich marine resources and alms provisions may have helped lessen the burden of these stressors during this period of climatic hardship. Additionally, while famine characterized the beginning of the 14th century, agricultural rebound shortly after this period may have also influenced the stress levels observed. [ABSTRACT FROM AUTHOR]

Cribra orbitalia has been the subject of much discussion since first described in the late 19th century. In particular, its relationship to porotic hyperostosis, anaemia, and malaria has been considered on many occasions. We have examined historical, embryological, developmental, anatomical, and pathological data to try to determine the significance of cribra. We conclude that three separate conditions have been included under this rubric: simple orbital porosity (cribra orbitalia sensu strictu), which is a normal developmental variant; deposits of periosteal new bone on the orbital roof; and an extensive inflammatory enlargement of the inner face of the orbital roof. These final two classes are pathological conditions that lead to a convex appearance of the orbital roof. In contradiction to authors treating cribra orbitalia as a precursor to porotic hyperostosis, we conclude that there is no evidence that the two are causally related. Consequently, cribra orbitalia sensu strictu should not be used as a surrogate for either anaemia or malaria. [ABSTRACT FROM AUTHOR]

Intra vitam porous lesions of the skull (Cribra Orbitalia and Porotic Hyperostosis) are pathological conditions due to genetic or acquired chronic anaemia. They are the most reported skeletal lesions in human skeletal remains and are routinely used to assess health, hygiene and nutritional status of past populations. Despite the existence of a number of proposed classifications, there is no generally accepted classification system used by all, with clear advantages over the others. Here, we propose a new evaluation form (BoPLE-Bone Porous Lesion Evaluation) that takes in consideration all the observable features of bone porous lesions, integrating existing qualitative criteria for the evaluation of severity and healing's conditions with a new quantitative analysis based on the count of pores per square centimetre. Porotic Hyperostosis and Cribra Orbitalia were investigated using the newly developed evaluation forms on 189 cranial bones from several distinct archaeological sites. Reliability and reproducibility of both existing qualitative scoring criteria and the new quantitative method were statistically tested. We believe that the new proposed classification system, which takes into consideration diverse parameters like surface area of lesion, location of lesion on cranial vault, and number of pits per surface area, represents a progress in the objective evaluation of porous bone lesions. Its use will allow the determination of the severity of the lesion and thus provide data to assess conditions of frailty in past populations. [ABSTRACT FROM AUTHOR]

Enamel hypoplasia (EH), porotic hyperostotsis (PH) and cribra orbitalia (CO) have frequently been used to indicate the presence non-specific stress during child-growth periods. They are routinely assessed to investigate health along with patterns of morbidity and mortality of past populations. This study aims use macroscopic analyses to describe and analyse the presence of EH, PH and CO in three prehistoric populations that lived in different environments - coastal and mountainous. For this study, we analysed human skeletons from Melolo, Lewoleba and Liang Bua- three sites situated in Nusa Tenggara Timur, Indonesia. The first two sites, Melolo, Sumba Island, and Lewoleba, are coastal sites whereas Liang Bua is located on a mountainous range in Flores. Excavations in Melolo, East Sumba, conducted in the 1930s, discovered 19 human skeletons buried in urns. Three individuals from the Melolo skeletal sample displayed EH (16%), 21% individuals were recorded to possess CO and 26% experienced PH. Excavation of the Lewoleba site, Lembata Island, were conducted in 1961 and yielded 5 human skeletons. No EH was observed in the Lewoleba sample but 40% displayed PH and CO was not found in the Lewoleba samples. The excavation of Neolithic skeletons from Liang Bua, Flores, yielded 7 individuals who displayed PH, CO, and EH (57%, 57% and 14% respectively). Surprisingly, the study in Liang Bua depicted the highest percentage compared to that of in Melolo and Lewoleba populations. [ABSTRACT FROM AUTHOR]

Objectives: Porotic lesions of the skull (cribra orbitalia and porotic hyperostosis) are one of the most common types of lesion identified in archaeological human bone and have also been found in hominins and non‐human primates. Because of the frequency with which such lesions are found there has been extensive debate on the possible causes and whether they are linked, with much of the debate centering on anemia. The biological approach to diagnosis in paleopathology used by Don Ortner and recently proposed more formally as a technique to facilitate diagnosis in paleopathology by Simon Mays may offer a means of answering some of the questions surrounding these lesions. Materials and Methods: A review was undertaken of biomedical information on changes in the distribution of marrow type and pattern of conversion of red and mixed marrow, and the potential for re‐conversion of yellow marrow with age. The range and type of other conditions that might result in the development of porous lesions were also considered. Results: Combining information from the biomedical literature on marrow type and patterns of conversion with age, with careful evaluation of the type and location of porous lesions in the skull and across the rest of the skeleton will assist in suggesting a diagnosis. Discussion: A wide range of conditions can produce porous lesions in the cranial vault and the orbital roof, but due to anatomical structures and physiological factors such lesions are more likely to occur in the orbital roof. Anemia can produce lesions in both locations, but evidence of marrow expansion is required to confirm it as a cause. [ABSTRACT FROM AUTHOR]

The study of stress from an osteological perspective is challenging as we use skeletal remains to explore the lived experience and patterns of health. As an intricate overlap of multiple biological processes, the stress response system guides our understanding of how and why stress manifests as it does. Using traditional osteological methods of stress analysis, specifically cribra orbitalia, porotic hyperostosis, and enamel hypoplastic lesions, this study focuses on the relationship between these indicators to explore differences in stress manifestation in the Medieval and post‐Medieval periods in Denmark. Using the Black Friars cemetery population (13th–17th centuries), results show an increase in stress from the Medieval into the post‐Medieval period likely dictated by the strains of urbanism on a predominantly poor population. Additionally, a younger mean age at death was noted when multiple mild–moderate indicators were present as compared with one severe indicator being present. A recognition of the intricacies of the stress response effectively aids in the exploration of stress manifestation and the relationship, if any, between these well‐used skeletal indicators. [ABSTRACT FROM AUTHOR]

Abstract: Intentionally opened skulls are considered to be the most fascinating of palaeopathological findings. This paper regards the discovery of a new trepanated skull dating from the Late Bronze and Early Iron Ages (1500–1400  BC) found at a burial site of Bardzryal, Armenia. Attention was first paid to trepanation technique, second—the description of methods of trepanations, third—to surgical procedures, and finally, to the cause of trepanation. The remains were examined by standard macromorphological and X‐ray methods of bioarchaeology. Bone nodules resulting from Dyke–Davidoff–Masson syndrome (DDMS) were observed on the endocranial surface of the frontal bone of a female. Regardless of provenance DDMS, which seems to be a possible cause of trepanation in women, is rarely seen in historic populations. Along with DDMS, porotic hyperostosis and osteomas were also observed. This observation constituted the first evidence of DDMS in the Late Bronze and Early Iron Age Armenia. [ABSTRACT FROM AUTHOR]

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This paper presents an bioarchaeological case study from Shirakavan. The skeletal remains belong to a male aged 40-45 years of age at death, with a stature above the average (177 cm). The presence of a horse skeleton in the discussed burial suggests that the human skeleton may have belonged to a horse rider. At the proximal end of the femur, there are some enthesopathies previously noted as common in horse riders. Analyses revealed a variety of pathologies, allowing inferences about the lifestyle and well-being of individual from Late Iron Age. The male suffered two cranial fractures, in nasal bones and frontal bone. Accidental falls involving facial injury may have contributed to antemortem tooth loss. Fractures ribs in the individual may be the result of direct blows to the chest or/from falling off of a horse. The clavicle injury observed in the individual discussed here can also be caused by a fall. There is degenerative pitting of the body of the neck vertebras indicating disc damage. Several vertebrae were asymmetrical (scoliosis). Perhaps mastoiditis was the leading cause of death at the individual from Shirakavan. [ABSTRACT FROM AUTHOR]

Se presenta el hallazgo fortuito, excavación y análisis de un enterratorio humano en Cabo Nose, Tierra del Fuego, Chile. El enterratorio se encontraba depositado en un conchal compuesto principalmente de choritos y mauchos, así como de algunos huesos de pescados, aves y mamíferos (lobo marino y guanaco). Los restos esqueletales correspondían a un individuo adulto joven de sexo masculino, fechado en 980 +/-40 años AP (Holoceno tardío). El esqueleto presenta hiperostosis porótica y espina bífida oculta, que posiblemente fueron consecuencia de una dieta rica en alimentos de origen animal pero pobre en vegetales y por tanto en folatos. Esta carencia nutritiva habría afectado al individuo durante el periodo gestacional (espina bífida oculta) y durante la niñez (hiperostosis porótica). Sin embargo, es también posible que un defecto genético haya causado los problemas congénitos (espina bífida y coaliciones tarsales) identificados en este individuo. El análisis isotópico indica un claro predominio de dieta marítima, lo cual concuerda con la evidencia paleopatológica.The discovery, excavation and analysis of a burial in Cabo Nose, Tierra del Fuego, Chile, is presented. The burial was deposited in a shell midden composed mostly of mussels and Nacella sp., as well as some fish, birds and mammal bones (sea lion and guanaco). The remains corresponded to a young adult male dated to BP 980+/-40 (Late Holocene). The skeleton showed porotic hyperostosis, spina bifida occulta, and deformities in the tarsal bones of the left foot. These anomalies were most likely the result of a folate dietary deficiency caused by the ingestion of a diet that was rich in meats, but poor in leafy-green vegetables. This dietary deficiency affected the individual during the gestational period (spina bifida occulta) and childhood (porotic hyperostosis). It is also possible, however, that the congenital defects seen in this individual (spina bifida occulta and tarsal coalitions), were the result of a genetic condition. The isotopic analysis shows that this individual consumed a diet that was predominantly maritime, which is in agreement with the paleopathological evidence.

Food at Teotihuacan was more likely affected by social inequality than by availability. The skeletons from Tlajinga 33 have high prevalence of skeletal indicators of morbidity. Since this was a lower-status compound of artisans, this could be due to poor diet, as well as an unhygienic environment. Analysis of faunal remains suggests that animal remains were an important and plentiful component of the diet. However, most consist of insects, small fish, reptiles, avian eggs, and small mammals. Of particular importance is the size and nutritional value of these dietary items, as many would be considered vermin which were available solely because of attraction to stored foods. It is important to employ proper recovery techniques to eliminate bias in size of animal remains to obtain an accurate understanding of the total diet. We demonstrate that there was adequate animal protein in the Tlajinga 33 diet, but it was very different than what is usually considered 'animal protein.' Thus, the residents had access to a nutritious and balanced diet, and this information eliminates protein deficiency as cause of the morbidity. Instead, the focus is on the urban environment and any status disadvantages faced by residents dependent on market exchange for staple foods. [ABSTRACT FROM AUTHOR]

In 2009, Walker and colleagues questioned the validity of the iron-deficiency anemia hypothesis as an explanatory mechanism for the presence of porotic hyperostosis (PH) and cribra orbitalia. They presented evidence demonstrating that iron deficiency inhibits, rather than promotes, marrow hypertrophy and argued a link between both PH and hemolytic or megaloblasic anemias (including vitamin B12 deficiency). This paper suggests that dismissing the iron-deficiency anemia hypothesis may be premature, but, if dismissed, may result in unforeseen consequences. Vitamin B12 deficiency and iron deficiency often result from similar proximate causes, i.e. lack of animal protein in the diet and sanitation problems that lead to parasitic or diarrheal diseases, thereby promoting nutrient losses. As a result, vitamin B12 deficiency and iron deficiency commonly co-occur. In individuals with a co-occurrence of iron deficiency and vitamin B12 deficiency, a possible inhibition of marrow hypertrophy caused by iron deficiency may prevent the development of PH, despite the presence of (vitamin B12) nutritional deficiency. The implications of dismissing the iron-deficiency anemia hypothesis are that many skeletal populations may exhibit hidden heterogeneity, i.e. individuals who are the most nutritionally stressed, with multiple nutrient deficiencies, would mimic the non-stressed individuals and neither would show evidence of PH. However, the inclusion of multiple stress indicators and greater understanding of biocultural context in bioarchaeological analyses may mitigate the potential impacts of hidden heterogeneity in the expression of PH. [ABSTRACT FROM AUTHOR]

During the late prehistoric period (AD 1250-1550) in the southeast USA, when native populations transitioned to living in permanent, nucleated settlements practicing maize agriculture, most experienced a decline in health. However, some research shows that not all groups experienced the decline in the same way as there were regional differences in dental caries and iron deficiency anaemia frequencies and patterns of physical activity. Therefore, the purpose of this study is to determine if regional differences in health also existed between late prehistoric upland and coastal inhabitants from one part of the southeastern USA. Pathological lesion frequencies were calculated for 441 individuals from 23 upland archaeological sites and compared with previously published data for 340 individuals from 11 coastal sites. Significant differences in lesion frequencies were observed between upland and coastal groups. For example, upland adult men have more carious teeth among the maxillary first incisors, maxillary second molars, mandibular canines, and mandibular second molars. For women, greater caries frequencies are found among the maxillary first and third molars, mandibular first incisors, and mandibular third premolars. Upland children show higher percentages of caries for 14 tooth classes. Coastal juveniles have a greater frequency of porotic hyperostosis, and more of them exhibit an enamel hypoplasia. Periosteal lesion frequency is greater for the coastal group at the humerus, radius, femur, and tibia. Lesions indicative of degenerative joint disease are more often found on the thoracic spinal segment, sacrum and shoulder of upland men with upland women having more lesions at the cervical, thoracic, and lumbar spinal segments, the sacrum, and the shoulder. Taken together, these results show that adults from the upland region consumed more maize and lived a more physically demanding life while coastal adults struggled more with infection. Among children, more coastal inhabitants were anaemic and more of the experienced significant growth disturbances. [ABSTRACT FROM AUTHOR]