Growth and bone mineralisation as affected by dietary calcium, phytic acid and vitamin D

Differential diagnosis of metabolic disease in a commingled sample from 19th century Hisban, Jordan

OBJECTIVE

This research attempts a differential diagnosis of skeletal lesions in a commingled sample from Hisban, Jordan, focusing on non-adults in the assemblage.

MATERIALS

2,883 well-preserved skeletal elements and 9 relatively complete skulls representing an MNI of 32 non-adults (<18 years old).

METHODS

All skeletal elements were observed macroscopically and pathophysiological processes underlying any lesions or other anomalies were assessed, followed by a comparative approach to rule out potential diagnoses.

RESULTS

The skeletal lesions observed were caused by inflammation due to chronic hemorrhaging, marrow hyperplasia due to an increase in hemopoiesis, rapid bone growth, and the impact of biomechanical strain on poorly mineralized elements. Rickets, scurvy, and acquired anemias best fit this pattern of lesions, although inflammation from other sources such as trauma or infection could not be definitively ruled out.

CONCLUSIONS

The in utero and postnatal environments at Hisban were conducive to the development of vitamin C and D deficiencies from birth until 2 years of age. The analysis of commingled remains requires an ontological shift in the importance of the individual to the population in paleopathology.

SIGNIFICANCE

This investigation demonstrates the efficacy of a combined biological and comparative approach in differential diagnosis in complicated commingled collections. In addition, it emphasizes the importance of the mother-infant dyad in understanding metabolic disease.

LIMITATIONS

Histological and radiographic analyses were not included in this diagnostic study due to COVID-19 travel restrictions.

SUGGESTIONS FOR FURTHER RESEARCH

Isotopic analysis to investigate childhood diet and histological and radiographic analyses to assess survival of deficiencies.

Pseudofracture of the neck of femur secondary to osteomalacia

Nutritional osteomalacia is a metabolic bone disorder common among the Asian female immigrant population in the United Kingdom. We describe the case of a female of Asian origin, who was found to have a unilateral undisplaced pseudofracture of the neck of the femur during pregnancy. Although not operated on the fracture was treated successfully with calcium and vitamin D supplement therapy. Within one month of treatment, the bone pain subsided and she was able to bear full weight. Subsequent radiological follow-up showed the pseudofracture to have healed sufficiently with no evidence of avascular necrosis.

There should be a high index of suspicion of this disease, particularly among Asian patients presenting with persistent and non-specific musculoskeletal pain.

Histologic study of the inhibition of bone resorption in organ cultures by myo-inositol-2-monophosphate

This study examines chemically and histologically the relative abilities of inositol monophosphate (IP1), inorganic phosphate (Pi), ethane-1-hydroxy-1, 1-diphosphonate (EHDP) and dichloromethylene disphosphonate (Cl2MDP) to inhibit parathyroid hormone (PTH)--induced resorption of fetal rat long bones in organ culture. Pregnant rats injected with 45Ca on the 18th day of gestation were killed the next day and their fetuses removed. Half of each pair of dissected long bones was incubated in a chemically defined control medium while the contralateral half was incubated in medium containing PTH or PTH plus the compound to be tested. 45Ca released into the medium was indicative of the amount of bone resorption. Bones were then processed histologically and examined microscopically. All compounds inhibited resorption to some extent with IP1 and Pi being less effective than EHDP or C12MDP at comparable phosphate concentrations. However, the disphosphonates damaged osteoclasts whereas IP1 and Pi did not. This suggests that IP1 may inhibit resorption by a different mechanism perhaps related only to prevention of crystal dissolution.