Biehler-Gomez L, Marklein K E, Mondellini M, Moro C, Mattia M, Fedeli A M, Cattaneo C
Laboratorio di Antropologia e Odontologia Forense (LABANOF), Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milan, Italy.
Department of Anthropology, University of Louisville, Louisville, Kentucky, USA.
Am J Biol Anthropol. 2025 Mar;186(3):e70025. doi: 10.1002/ajpa.70025.
In bioarchaeology, the concepts of resilience and frailty, and their quantification through indices, have gathered significant attention. This study is the first to apply, evaluate, and compare skeletal frailty indices and aims to trace frailty over time while identifying methodological challenges in their use on a sample representative of urban Milan's history.
Two-hundred fifty individuals from five historical periods over 2000 years in urban Milan, equally represented by estimated males and females, were analyzed. Three skeletal frailty indices were applied-the "Health Index" GHHP, "Skeletal Frailty Index" (SFI), and "Biological Index of Frailty" (BIF)-and their diachronic variations interpreted. Index values were compared to each other through Spearman's correlations, and frailty values were assessed by periods (overall and by estimated sex) and by estimated sex through ANOVA and General Linear Models.
Diachronic analyses revealed a gradual increase in frailty from the Roman era to the Late Middle Ages, which then progressively decreased, corroborating historical sources. While all methods identified the Late Middle Ages sample as the frailest, discrepancies arose when defining the least frail group, especially when considering estimated biological sex and age variables.
Our study found practical and conceptual limitations in the GHHP. Most noticeably, criteria for GHHP and SFI limited sample size (and consequently) representation, while the more inclusive BIF proved overly permissive, allowing direct comparisons between skeletons with differential preservation. This study highlights common challenges and prospects, defines common criteria to standardize methodologies, and further investigates the relevance of stress markers in relation to frailty.
在生物考古学中，复原力和脆弱性的概念及其通过指数进行的量化已引起广泛关注。本研究首次应用、评估和比较骨骼脆弱指数，旨在追踪随时间变化的脆弱性，同时确定在代表米兰城市历史的样本上使用这些指数时的方法学挑战。
对米兰市区2000多年来五个历史时期的250个人进行了分析，估计的男性和女性人数相等。应用了三种骨骼脆弱指数——“健康指数”GHHP、“骨骼脆弱指数”（SFI）和“脆弱生物指数”（BIF），并解释了它们的历时变化。通过斯皮尔曼相关性对指数值进行相互比较，并通过方差分析和一般线性模型按时期（总体和按估计性别）以及按估计性别评估脆弱性值。
历时分析显示，从罗马时代到中世纪晚期脆弱性逐渐增加，随后逐渐下降，这与历史资料相符。虽然所有方法都将中世纪晚期的样本确定为最脆弱的，但在定义最不脆弱的群体时出现了差异，尤其是在考虑估计的生物学性别和年龄变量时。
我们的研究发现GHHP在实际应用和概念上存在局限性。最明显的是，GHHP和SFI的标准限制了样本量（进而限制了代表性），而包容性更强的BIF被证明过于宽松，允许对保存情况不同的骨骼进行直接比较。本研究突出了常见的挑战和前景，定义了标准化方法的通用标准，并进一步研究了压力标志物与脆弱性的相关性。
