Patterns of frailty in non-adults from medieval London

Assessing the association of skeletal indicators of stress with mean age-at-death in sub-adults

OBJECTIVES

The present study investigated the association of skeletal indicator of stress presence with mean age-at-death as a means of understanding whether commonly studied indicators are indeed indicative of increased frailty.

MATERIALS AND METHODS

Using a medieval Gaelic population from Ballyhanna (Co. Donegal), the present study assessed the association between skeletal indicators of stress and mean age-at-death using the Kaplan-Meier survival function with log rank test to determine whether these indicators were associated with younger age-at-death, and therefore increased frailty, in sub-adults only (0 to 18 years, N = 139) and through comparison to an all-ages cohort (N = 318).

RESULTS

Only linear enamel hypoplasia was found to be associated with significantly decreased survivorship across the all-ages cohort but, conversely, was associated with increased survivorship when analysis was restricted to sub-adults. All other indicators assessed were associated with increased age-at-death for both all-age cohorts and sub-adult cohorts (cribra orbitalia), increased age-at-death when assessing all ages only (porotic hyperostosis and healed periosteal lesions); or were sufficiently rare in adults to prevent comparative analysis (stunting and micronutrient deficiency). Increased survivorship in individuals with higher numbers of co-morbid skeletal indicators was observed for both sub-adults alone and all age cohort.

DISCUSSION

These findings suggest that these commonly recorded skeletal indicators may be more accurately viewed simply as records of stressor exposure and subsequent survival only, rather than providing evidence that these sub-adults are frailer than their similarly aged-at-death peers. Thus, the demographic and sociocultural context is essential to the interpretation of observed skeletal indicators of stress.

The Black Death in Hereford, England: A demographic analysis of the Cathedral 14th-century plague mass graves and associated parish cemetery

OBJECTIVES

This study explores the paleoepidemiology of the Black Death (1348-52 AD) mass graves from Hereford, England, via osteological analysis. Hereford plague mortality is evaluated in the local context of the medieval city and examined alongside other Black Death burials.

METHODS

The Hereford Cathedral site includes mass graves relating to the Black Death and a 12th-16th century parish cemetery. In total, 177 adult skeletons were analyzed macroscopically: 73 from the mass graves and 104 from the parish cemetery. Skeletal age-at-death was assessed using transition analysis, and sex and stress markers were analyzed.

RESULTS

The age-at-death distributions for the mass graves and parish cemetery were significantly different (p = 0.0496). Within the mass graves, young adults (15-24 years) were substantially over-represented, and mortality peaked at 25-34 years. From 35 years of age onwards, there was little variation in the mortality profiles for the mass graves and parish cemetery. Males and females had similar representation across burial types. Linear enamel hypoplasia was more prevalent within the mass graves (p = 0.0340) whereas cribra orbitalia and tibial periostitis were underrepresented.

CONCLUSIONS

Mortality within the Hereford mass graves peaked at a slightly older age than is seen within plague burials from London, but the overall profiles are similar. This demonstrates that young adults were disproportionately at risk of dying from plague compared with other age groups. Our findings regarding stress markers may indicate that enamel hypoplasia is more strongly associated with vulnerability to plague than cribra orbitalia or tibial periostitis.

Demographics and significance of porotic hyperostosis as assessed by surface microscopy

BACKGROUND

Examination of parietal surface anatomy has been limited because standard techniques have insufficient resolution to identify and characterize the structures of interest. Perspectives derived thereof have not clarified their nature. Surface microscopy is pursued as a non-destructive technique to assess the character and implications of porotic pores (referred to as porotic hyperostosis), which have been subject of much speculation.

METHODS

The external surface of skulls, selected on the basis of age and gender, from the Hamann-Todd human collection are examined by epi-illumination microscopy for surface pores and to assess correlation with age, ethnicity, gender, anemia, infection, cancer, hypertrophic bone disorders, renal disease and fractures.

RESULTS

Pore-like surface defects are present in 2.7-5% of individuals in the third-fifth decades of life; 7%, in the sixth-eighth; and 25%, in the ninth-11th, but absent in the second decade of life. They are gender and birthdate-independent, but slightly more common in African Americans. Fractures are more common among individuals with parietal pores, while tuberculosis, cancer and hypertrophic bone diseases and anemia are less common.

DISCUSSION

This is the first study to actually examine the prevalence of parietal pores as a function of known age, race and sex and provides a baseline for comparison with populations in which those variables are not clearly identifiable. While some porotic pores may be related to marrow hyperplasia, trans-cortical circulation may explain the majority. This article is protected by copyright. All rights reserved.

Cribra orbitalia is correlated with the meningo-orbital foramen and is vascular and developmental in nature

Cribra orbitalia is a phenomenon with interdisciplinary interest. However, the etiology of cribra orbitalia remains unclear. Recently, the appearance of cribra orbitalia was identified as vascular in nature. This study assessed the relationship between anatomical variation of vasculature, as determined by the presence of meningo-orbital foramina, and the presence of cribra orbitalia in 178 orbits. Cribra orbitalia was identified in 27.5% (49:178) of orbits (22.7%, 35:154 adult orbits and 58.3%, 14:24 subadult orbits) and meningo-orbital foramina were identified in 65.8% (100:152) of orbits. Among the 150 total intact adult orbits (i.e., orbital roof and posterior orbits both intact), cribra orbitalia was found in 35 (23.3%). Of these 35 occurrences of cribra orbitalia, 32 (91.4%) had the concurrent finding of a meningo-orbital foramen. However, in the absence of the meningo-orbital foramen, cribra orbitalia was only found in three sides out of the total sample of intact orbits (3:150; 2.0%). Fisher's exact test revealed that the presence of cribra orbitalia and the meningo-orbital foramen were statistically dependent variables (p = .0002). Visual evidence corroborated statistical findings-vascular impressions joined cribra orbitalia to meningo-orbital foramina. This study identifies that individuals who possess a meningo-orbital foramen are anatomically predisposed to developing cribra orbitalia. Conversely, cribra orbitalia is unlikely to occur in an individual who does not possess a meningo-orbital foramen. Thus, the antecedent of cribra orbitalia is both vascular and developmental in nature. This report represents an important advancement in the understanding of cribra orbitalia-there is an anatomical predisposition to the development of cribra orbitalia.

The biological index of frailty: A new index for the assessment of frailty in human skeletal remains

OBJECTIVE

Frailty is the physiological stress that individuals suffer during their life. In past populations, frailty is conventionally assessed through the occurrence of different biomarkers of biological stress. Some efforts have been made to propose indexes that combine all biomarkers. However, these indices have some critical limitations: they cannot be used on incomplete skeletons, do not consider the severity and/or healing of lesions, and assign equal importance to different biomarkers. To address these limitations, we propose a new index to assess frailty in skeletal individuals.

MATERIAL AND METHODS

By statistically analyzing a large amount of osteological data available from the Museum of London, and using a Logit model, we were able to define a different weight for each reported biomarker of frailty, based on their importance in increasing the risk of premature death for the individuals.

RESULTS

The biological index of frailty (BIF) is the weighted mean of all biomarkers scored on the individuals, according to a different degree of importance assigned to each one. It also considers the severity and healing of the biomarkers when this is relevant to diagnose frailty. We applied BIF on a sample of Monastics and Non-Monastics from medieval England and compared it with the skeletal index of frailty (SFI).

DISCUSSION

BIF is the first frailty index that gives a different weight to each skeletal biomarker of stress, considers both severity and healing of the lesions, and can be applied on partial skeletal remains. The comparison with SFI showed that BIF is applicable to a larger number of skeletal individuals, revealing new differences between the Monastic and the Non-Monastic groups.

A comparison of subadult skeletal and dental development based on living and deceased samples

OBJECTIVES

A fundamental assumption in biological anthropology is that living individuals will present with different growth than non-survivors of the same population. The aim is to address the question of whether growth and development data of non-survivors are reflective of the biological consequences of selective mortality and/or stress.

MATERIALS AND METHODS

The study compares dental development and skeletal growth collected from radiographic images of contemporary samples of living and deceased individuals from the United States (birth to 20 years) and South Africa (birth to 12 years). Further evaluation of deceased individuals is used to explore differential patterns among manners of death (MOD).

RESULTS

Results do not show any significant differences in skeletal growth or dental development between living and deceased individuals. However, in the South African deceased sample the youngest individuals exhibited substantially smaller diaphyseal lengths than the living sample, but by 2 years of age the differences were negligible. In the US sample, neither significant nor substantial differences were found in dental development or diaphyseal length according to MOD and age (>2 years of age), though some long bones in individuals <2 years of age did show significant differences. No significant differences were noted in diaphyseal length according to MOD and age in the SA sample.

DISCUSSION

The current findings refute the idea that contemporary deceased and living individuals would present with differential growth and development patterns through all of ontogeny as well as the assumptions linking short stature, poor environments, and MOD.

Evaluating life history trade-offs through the presence of linear enamel hypoplasia at Pueblo Bonito and Hawikku: A biocultural study of early life stress and survival in the Ancestral Pueblo Southwest

OBJECTIVES

Due to the indelible nature of enamel, bioarchaeologists use linear enamel hypoplasia (LEH) to detect early investments in surviving stress and have identified an association between LEH presence and constraints in growth and maintenance as well as an increased susceptibility to future stress events. This study evaluates heterogenous frailty and susceptibility to death in relation to episodes of early life stress, as reflected by LEH presence, in the Ancestral Pueblo Southwest. This study hypothesizes that LEH presence will be associated with decreased survivorship and an increased likelihood of mortality in both samples.

MATERIALS AND METHODS

This study uses two samples, one from Pueblo Bonito (A.D. 800-1200; n = 28) and the second from Hawikku (A.D. 1300-1680; n = 103). Kaplan-Meier survival analysis with a log-rank test was used to evaluate the effect of LEH presence on survivorship for the two samples.

RESULTS

Survival analysis reveals statistically significant differences in mortality risk between individuals with and without LEH for the Hawikku sample, but no significant differences for the Pueblo Bonito sample.

CONCLUSION

The results demonstrate differences in the response to early life stress at the Hawikku and Pueblo Bonito sites, likely reflecting context. The Pueblo Bonito sample represents a high-status group, and survival following LEH may be the result of cultural buffering. Hawikku dates to a period associated with increased levels of disease and malnutrition as well as Spanish colonization. This environment may have exacerbated mortality risk for individuals in the region who survived early life stress and signifies the consequences of European colonialism in the New World.

Prevalence and outcomes of fragility: a frailty-inflammation phenotype in children with chronic kidney disease

BACKGROUND

Frailty is a condition of decreased physiologic reserve and increased vulnerability to stressors. Frailty in combination with inflammation has been associated with increased mortality risk in adults with advanced chronic kidney disease (CKD). This study aimed to investigate prevalence and outcomes associated with a frailty-inflammation phenotype, or "fragility," in children with CKD.

METHODS

We analyzed 557 children (age 6-19 years, eGFR 30-90 ml/min/1.73 m²) from the Chronic Kidney Disease in Children (CKiD) study. Based on adult models, the CKiD fragility model included four indicators: (1) suboptimal growth/weight gain (BMI < 5th percentile-for-height-age, deceleration ≥ 10 BMI-for-height-age percentiles/1 year, height-for-age percentile < 3rd or deceleration ≥ 10 height percentiles/1 year); (2) low muscle mass (mid-upper-arm circumference < 5th percentile or deceleration ≥ 10 percentiles/1 year); (3) fatigue (parent/child report); (4) inflammation (CRP > 3 mg/l). Logistic regression was used to evaluate association of fragility indicators with three adverse outcomes: frequent infection (> 1 per year/3 years), hospitalization (any), and rapid CKD progression (decline in eGFR > 30% or initiation of renal replacement therapy within 3 years).

RESULTS

Prevalence of fragility indicators 1 year after study entry were 39% (suboptimal growth/weight gain), 62% (low muscle mass), 29% (fatigue), and 18% (inflammation). Prevalence of adverse outcomes during the subsequent 3 years were 13% (frequent infection), 22% (hospitalization), and 17% (rapid CKD progression). Children with ≥ 3 fragility indicators had 3.16-fold odds of frequent infection and 2.81-fold odds of hospitalization, but did not have rapid CKD progression.

CONCLUSIONS

A fragility phenotype, characterized by the presence of ≥ 3 indicators, is associated with adverse outcomes, including infection and hospitalization in children with CKD.