Pathology

Question 1

How can pathologies assist the FoAn?

Answer 1

1. Where multiple individuals share very similar biological profiles, pathology or past trauma may be the key identifying factor. The rarer the pathology, the better.
2. If the pathology is the result of trauma, medical records may exist and can be compared to remains to aid in identification.

Question 2

Challenges of skeletal pathologies

Answer 2

1. Must be able to distinguish between pathology, trauma, and taphonomic processes. Plants (roots) and animals may cause holes etc. which mimic disease.
2. Bone has very limited responses to disease = build up or break down. Many diseases will have similar appearances > differential diagnosis.
3. Incomplete skeletons may make diagnosis difficult if key discerning elements are not present.
4. Must determine how the pathology affected the individual in life, how it will have manifested to those around them > this is the identifying factor.

Question 3

Affect of pathology on bio profile

Answer 3

1. Ancestry: pathologies may manifest differently in differing populations, being more prevalent or severe in certain ancestral groups which may aid in ancestry estimation.
2. Sex: Osteoarthritis may obscure pelvic morphology limiting its use in sex estimation.
3. Age: Bone diseases such as osteoporosis and osteoarthritis cause degenerative changes, causing the skeleton to appear older than it is.
4. Stature: Certain pathologies may affect bone length or disrupt bone growth (osteomalacia or rickets).

Question 4

what does presence of skeletal lesions indicate?

Answer 4

1. Severe stress > good immunity > chronic ill health > bone reacts resulting in observable changes > individual dies (possibly unrelated) . pathology evident on bone.
2. Skeletal pathologies are likely to represent the healthier individuals as they lived with and fought disease for a significant period of time.

Question 5

What does absence of skeletal lesions indicate?

Answer 5

1. Absence of evidence is not the evidence of absence. Bone is often the last structure to respond to disease = no skeletal lesions simply mean the disease killed the individual before affecting the bone.
2. severe stress > poor immunity > bone has no time to react > person dies > no changes observed.
3. Could mean individual was perfectly healthy and died of accidental causes.

Question 6

Bone response to disease

Answer 6

1. Bone formation by osteoblasts.
2. Bone resorption by osteoclasts.
3. Mixed bone response = both involved.
4. Lytic lesions: osteoclast activity greater than osteoblast = bone destruction.
5. Blastic lesions: osteoblasts greater than osteoclast = increased bone formation + density.

Question 7

Periostitis (non-specific)

Answer 7

1. Inflammation of periosteum leads to increased blood supply and bone formation > eventual remodelling.
2. Woven bone forms rapidly and poorly attached, colour of soil.
3. Compact lamellar bone will form over time; organised, striated structure: forms slowly due to chronic conditions or healing of woven bone.

Question 8

Osteitis (non-specific)

Answer 8

1. Inflammation of bone substance = increased formation/thickening.
2. Decreased diameter of medullary cavity = remodelling occurs.

Question 9

Osteomyelitis (non-specific)

Answer 9

1. Bone infections: medullary cavity, cortical bone; local or diffuse; acute or chronic.
2. Cause resorption or formation and cloaca formation.
3. Caused by: direct open fractures, local soft tissue spread, blood borne infections.
4. May cause sequestrum formation = isolated bone segment or involucrum = sheath around cortical bone.
5. Soft tissue indication = fistula/sinus forms as drainage channel for infection.

Question 10

Reactive arthropathies (non-specific)

Answer 10

1. Joint degeneration or fusion as a result of infection.
2. Can be septic arthritis or Reiter’s syndrome.
3. Septic arthritis = infection spreads from blood to joints, bacteria enter synovium and joint capsule causing inflammation and destroying cartilage = erodes joint surface = ankylosis/fusion occurs if untreated.

Question 11

Tuberculosis (specific)

Answer 11

1. Caused by mycobacterium.
2. Acute or chronic.
3. Blood borne or via direct contact.
4. Lytic lesions affect ribs and spine.
5. Septic arthritis + ankylosis cause collapse of vertebral bodies due to destructive lesions = Pott’s Kyphosis.
6. On the rise in vulnerable populations: preventable and treatable.

Question 12

Syphilis (specific)

Answer 12

1. Treponemal bacterial disease
2. Venereal or congenital.
3. Venereal causes distinctive lesions on cranial vault = Caries sicca
4. Tertiary syphilis: chronic and multifocal = sclerotic lesion formation as a result of bone formation or destruction. Rhino-maxillary bone resorption may occur

Question 13

Charcot’s joint (specific)

Answer 13

1. Peripheral neurotrophic arthropathy: a secondary condition which results from infectious disease. Loss of peripheral nerve function can be caused by neurosyphilis or type 2 diabetes.
2. Ankylosis of the joint caused by repeated trauma due to individual being unaware or unable to prevent it.

Question 14

Anaemia (nutritional and metabolic)

Answer 14

1. Lack of/low RBC cause marrow to expand in an effort to resupply = widening of medullary cavity, cortical thinning, widening metaphyses.
2. Porotic Hyperostosis: symmetrical lesions on the frontal and parietal bones; thickening and coarsening of diploe with a loss of outer cortical surface = porosity
3. Cribra orbitalia: similar to PH but limited to orbital roof.
4. Argued that low iron levels prohibit erythropoiesis so cannot be the cause of PH or CO.

Question 15

Vitamin D deficiency (nutritional and metabolic)

Answer 15

1. Maintains blood calcium levels, lack causes rickets or osteomalacia.
2. Caused by lack of sunlight or inadequate nutrition.
   3.In children: cartilage ossification centres fail to calcify which restricts cartilage proliferation, stunting growth = failure to create an adequate precursor for bone.
3. Bones will be malformed and shortened with flaring, may cause scoliosis and thinning of cranial elements.
4. osteomalacia = bowing of weight baring elements.

Question 16

Vitamin C (scurvy)

Answer 16

1. Deficiency results in defective collagen and osteoid synthesis which may cause growth retardation.
2. Hemorrhagic phenomenon = subperiosteal bleeding causes formation of new bone under periosteum = increased porosity.
3. mouth may also be affected with bleeding gums and loose teeth.
4. White line of Frankel = radiographic evidence of scurvy, seen at edge of metaphysis.