New findings in the identification of adult vitamin D deficiency osteomalacia: Results from a large-scale study.

This is the first systematic large-scale palaeopathological study of adult vitamin D deficiency osteomalacia. One thousand one hundred and eighty-one skeletons from multiple urban contexts in post-mediaeval England (c. AD 1700-1855) were analysed. Twelve adults with evidence of osteomalacia were identified. When added to the seven cases previously identified by Brickley et al. (2007) the individual prevalence rate increased to 19 of 1323 individuals (1.43%). New lesions affecting the medial ilium, scapula coracoid process, proximal femur and vertebrae are presented. These are infrequently occurring indicators, but are important in expanding the previously documented range of skeletal changes of adult osteomalacia and may aid the future identification of this condition in archaeological human remains. Importantly, the pathological lesions recorded in archaeological skeletons were different in expression to those observed in pathology museum collections. The more extreme changes found in many museum collections were not identified in this study. A trend for osteomalacia to have occurred in older adults is demonstrated in these results, raising questions over the impacts on health at different stages of the life course.