Brickley Megan B, Mays Simon, George Michele, Prowse Tracy L
Department of Anthropology, McMaster University, 1280 Main Street West, Hamilton, L8S 4L9, Canada.
Historic England, Fort Cumberland Rd, Portsmouth, PO4 9LD, United Kingdom.
Int J Paleopathol. 2018 Dec;23:43-53. doi: 10.1016/j.ijpp.2018.01.001. Epub 2018 Jan 17.
Paleopathological investigations of conditions linked to vitamin D deficiency have increased in the last twenty years, and a suite of skeletal lesions has been established to aid in the diagnosis of vitamin D deficiency disease in subadults and adults. This paper analyzes the occurrence of these lesions in a large skeletal series comprising 3541 Roman period individuals (1st-6th century AD). Sixteen lesions reported in rickets in subadults, and 13 associated with residual rickets and osteomalacia in adults, were analyzed. Among subadults, there were clear associations among post-cranial lesions. Porotic cranial changes were associated with each other, but not with post-cranial lesions. A range of conditions could have produced the cranial lesions. There was a general paucity of correlations between indicators found in adults, and the difficulty in recording bending deformities was clear. Pseudofractures appear to provide a useful means of investigating osteomalacia in adults. In general, a simple algorithmic approach using presence or absence of lesions is unlikely to provide an adequate means of diagnosing vitamin D deficiency in paleopathology. Knowledge and consideration of the underlying physiological mechanisms involved in lesion formation, combined with individual judgement, will be required to differentially diagnose cases.
在过去二十年中，与维生素D缺乏相关病症的古病理学研究有所增加，并且已经确定了一系列骨骼病变，以帮助诊断亚成年人和成年人的维生素D缺乏症。本文分析了在一个包含3541名罗马时期个体（公元1至6世纪）的大型骨骼样本中这些病变的发生情况。分析了亚成年人佝偻病中报告的16种病变，以及成年人中与残留佝偻病和骨软化症相关的13种病变。在亚成年人中，颅后病变之间存在明显关联。颅骨疏松变化相互关联，但与颅后病变无关。一系列情况都可能导致颅骨病变。成年人中发现的指标之间普遍缺乏相关性，而且记录弯曲畸形的难度很明显。假骨折似乎为研究成年人骨软化症提供了一种有用的方法。一般来说，使用病变是否存在的简单算法方法不太可能为古病理学中维生素D缺乏症的诊断提供充分手段。需要结合对病变形成所涉及的潜在生理机制的了解和考虑以及个人判断来对病例进行鉴别诊断。
