Harris lines: a study of age-associated bias in counting and interpretation

Pathology or expected morphology? Investigating patterns of cortical porosity and trabecularization during infancy and early childhood

Increased cortical porosity is associated with a heightened risk of skeletal fragility due to bone loss and structural decay in adults. However, few studies have examined the etiology of cortical porosity in infants and children. This study examines whether age-related changes in femoral growth and locomotor development influence femoral midshaft cortical porosity in a sample of 48 individuals (fetal to 3.99 years) from the 10th-13th century cemetery of St. Étienne de Toulouse, France. Histological sections were prepared and imaged using light microscopy. Midshaft geometric variables such as total area, cortical area, and pore area were calculated using BoneJ. Increased porosity and cortical trabecularization were found to be significantly associated with age, being almost exclusively present in individuals aged 0.5-1.99 years. At approximately 6 months of age infants typically begin engaging in regular femoral loading and experience an acceleration in growth. The observed increase in midshaft porosity and trabecularization, therefore, likely results from the reorganization and redistribution of cortical bone, stimulated by increased growth velocity and the onset of weight-bearing activities. The reduction in cortical porosity and trabecularization in individuals aged 2.0-3.99 years indicates that children are approaching some sort of homeostasis as growth velocity slows and their femora adapt to consistent loading. Understanding what expected skeletal development looks like is necessary when conducting bioarcheological studies and this study provides evidence for a pattern of transient midshaft porosity during infancy and early childhood.

Growth recovery lines in children: A comparison between psychosocial short stature and other pathological causes of short stature

BACKGROUND

Psychosocial short stature (PSS) is a rare disorder associated with emotional deprivation. Growth recovery lines (GRLs), the radiodense bands in metaphyseal bones, are indicators of stress.

OBJECTIVE

To evaluate the efficacy of using GRLs in the distal radius to identify PSS.

PARTICIPANTS AND SETTING

This retrospective cohort study included children 15-138 months of age with short stature whose hands and wrists were radiographed between 2011 and 2020 at Matsuyama Red Cross Hospital in Japan.

METHODS

PSS was determined if a child with short stature had been reported to be abused or neglected. Other pathological short statures were diagnosed per the established criteria. GRLs, height velocity before and after specific treatment, insulin-like growth factor 1, and the difference between chronological and skeletal age were assessed.

RESULTS

The PSS and other short stature groups comprised of 7 and 11 children, respectively. The body mass index of the PSS group was smaller than that of other short stature group (-1.15 standard deviation [SD] vs. 0.57 SD, P = 0.003). The PSS group had significantly more GRLs than the other group (5.3 vs. 0.5, P = 0.011). Height velocity before treatment in the PSS group was significantly lower (-5.46 SD vs. -1.86 SD, P = 0.005), with no significant differences in other variables. The specificity for PSS was >90% when children with short stature had at least three GRLs in both distal radii.

CONCLUSIONS

Abuse or neglect should be considered in children with short stature having multiple GRLs in the distal radius.

Growth recovery lines: a specific indicator of child abuse and neglect?

BACKGROUND

Growth recovery lines are radiodense lines in long bones reported to be indicators of stress.

OBJECTIVE

The purpose of this study was to understand the distribution, quantity and associations of growth recovery lines in children ages 0-24 months with high and low risk for child maltreatment.

MATERIALS AND METHODS

We conducted a retrospective cohort study of children ages 0-24 months who had skeletal surveys and an assessment for maltreatment. Growth recovery lines, fractures and osteopenia were assessed independently by two pediatric radiologists blinded to the abuse likelihood.

RESULTS

Of the 135 children in this study, 58 were in the low-risk group, 26 were in the neglect group, and 51 were in the physical abuse group. Children in the neglected and physically abused groups had 1.73 times (95% confidence interval [CI] of 1.16, 2.59), P=0.007) and 1.84 times (95% CI 1.28, 2.63, P<0.001) more growth recovery lines than the low-risk group, respectively. Growth recovery lines occurred at an earlier age in the neglect group (age interaction P=0.03) and abuse group (age interaction P=0.01) compared to the low-risk group. The specificity for maltreatment in children with at least 10 growth recovery lines in the long bones was greater than 84%, while sensitivity was less than 35%. The most common locations for growth recovery lines were distal radius, proximal tibia and distal tibia.

CONCLUSION

In the absence of a known major stressor, physical abuse and neglect should be considered in children younger than 24 months with at least 10 growth recovery lines.

Normal growth, altered growth? Study of the relationship between harris lines and bone form within a post-medieval plague cemetery (Dendermonde, Belgium, 16th Century)

OBJECTIVES

Harris lines (HLs) are defined as transverse, mineralized lines associated with temporary growth arrest. In paleopathology, HLs are used to reconstruct health status of past populations. However, their etiology is still obscure. The aim of this article is to test the reliability of HLs as an arrested growth marker by investigating their incidence on human metrical parameters.

METHODS

The study was performed on 69 individuals (28 adults, 41 subadults) from the Dendermonde plague cemetery (Belgium, 16th century). HLs were rated on distal femora and both ends of tibiae. Overall prevalence and age-at-formation of each detected lines were calculated. ANOVA analyses were conducted within subadult and adult samples to test if the presence of HLs did impact size and shape parameters of the individuals.

RESULTS

At Dendermonde, 52% of the individuals had at least one HL. The age-at-formation was estimated between 5 and 9 years old for the subadults and between 10 and 14 years old for the adults. ANOVA analyses showed that the presence of HLs did not affect the size of the individuals. However, significant differences in shape parameters were highlighted by HL presence. Subadults with HLs displayed slighter shape parameters than the subadults without, whereas the adults with HLs had larger measurements than the adults without.

CONCLUSIONS

The results suggest that HLs can have a certain impact on shape parameters. The underlying causes can be various, especially for the early formed HLs. However, HLs deposited around puberty are more likely to be physiological lines reflecting hormonal secretions. Am. J. Hum. Biol. 29:e22885, 2017. © 2016 Wiley Periodicals, Inc.

Harris lines observed in human skeletons of Joseon Dynasty, Korea

The Harris line (HL), caused by bone-growth arrest and manifesting on X-rays as a radiopaque transverse line in the metaphysis of the long bones, is an indicator reflecting stress conditions such as disease or malnutrition. HL frequency has been assumed to differ between pre-modern and modern societies, as reflective of increased caloric intake and overall nutritional improvements attendant on industrialization. To determine if such a change occurred in Korea, in the present study we compared the respective HL statuses in medieval Joseon and modern Korean population samples. HLs were found in 39.4% (28/71) of the Joseon Koreans. Whereas only 27.5% (11/40) of the males showed an HL, fully 54.8% (17/31) of the females exhibited it. Notably, HLs were observed in only 16.4% (35/213) of the modern Koreans; more remarkably still, the HL rate was almost the same between the sexes, 16.7% (20/120) for the males and 16.1% (15/93) for the females. The HL frequency was much higher in the Joseon Koreans than in their modern counterparts, reflecting the improvement of nutritional status that had been achieved in the course of South Korea's modernization. This HL-frequency decrease was much more obvious in the female populations. The higher HL frequency among the Joseon females might reflect the relatively poor nutritional condition of females in pre-modern Korean society.

Experimental assessment of nutrition and bone growth's velocity effects on Harris lines formation

Harris lines (HL) are radio-opaque transverse lines traditionally associated with stressors that halt or decelerate growth in humans. Harris lines' status as a stress marker is, however, questionable because their association to illness and deficient growth is low and they commonly form in the absence of stress during periods of accelerated growth. To assess Harris line's reliability as a stress marker, this study examined their association with nutritional status and bone growth velocity through an experimental study in rabbits. Forty-five New Zealand White rabbits were divided into: Control (normal laboratory conditions), Experimental-1 (moderately undernourished), and Experimental-2 (periodically fasted) groups during their growth. Variables analyzed included weight, forelimb length, humeral diaphyseal length, diaphyseal growth velocity, and number of Harris lines. Fewer lines were observed by the end of the study among Experimental-1 animals. More Harris lines formed during periods of rapid growth in the absence of nutritional stress. Accordingly, Harris lines are a poor marker of stress. Intrinsic limitations to paleopathological studies can be overcome, but even the most careful attentiveness to multiple stress markers and cultural context will go amiss if the markers used are unreliable.

Technical note: standardized and semiautomated Harris lines detection

Arrest in long bone growth and the subsequent resumption of growth may be visible as radiopaque transverse lines in radiographs (Harris lines, HL; Harris, HA. 1933. Bone growth in health and disease. London: Oxford University Press). The assessment of individual age at occurrence of such lines, as part of paleopathological skeletal studies, is time-consuming and shows large intra- and interobserver variability. Thus, a standardized, automated detection algorithm would help to increase the validity of such paleopathological research. We present an image analysis application facilitating automatic detection of HL. On the basis of established age calculation methods, the individual age-at-formation can be automatically assessed with the tool presented. Additional user input to confirm the automatic result is possible via an intuitive graphical user interface. Automated detection of HL from digital radiographs of a sample of late Medieval Swiss tibiae was compared to the consensus of manual assessment by two blinded expert observers. The intra- and interobserver variability was high. The quality of the observer result improved when standardized detection criteria were defined and applied. The newly developed algorithm detected two-thirds of the HL that were identified as consensus lines between the observers. It was, however, necessary to validate the last one-third by manual editing. The lack of a large test series must be noted. The application is freely available for further testing by any interested researcher.

Medicolegal anthropology in France

Medicolegal anthropology has a very long history in France. Basic studies on human skeletal remains started as early as the 18th century. The 19th century produced many medical theses and research papers on age, sex, as well as stature estimation. The research proliferated in the first 60 years of the 20th century, much of which is still in use in France and abroad. The later half of the 20th century, however, was dormant in research on human skeletal biology at a time when forensic anthropology was becoming an active field worldwide. In the last decade, medicolegal anthropology took a different perspective, independent of its traditional roots. Research and practice have both been in the professional domain of forensic physicians unlike the situation in many other countries. Population based studies requiring large databases or skeletal collections have diminished considerably. Thus, most research has been on factors of individualization such as trauma, time since death, crime scene investigation, and facial reconstruction. It is suggested that there is a need for cooperation between the forensic physician and anthropologist to further research. This also encourages anthropologists to carry out research and practice that can fulfill the needs of the medicolegal system of the country.