Anemia or scurvy: A pilot study on differential diagnosis of porous and hyperostotic lesions using differential cranial vault thickness in subadult humans

Abstract

Metabolic disorders, such as scurvy, manifested in human skeletal remains provide insight into health, nutrition, and environmental quality in past populations. Porous cranial vault lesions are often used to diagnose metabolic conditions in subadult remains, but overlapping gross lesion expressions have led to over-diagnosis of anemia and under-diagnosis of scurvy. Studies by Ortner and colleagues have suggested that specific porous cranial lesions are pathognomonic of scurvy, but additional diagnostic tools are necessary. In this technical report, we offer a preliminary assessment of cranial vault thickness (CVT) at the site of porous lesions (sensu lato porotic hyperostosis, cribra orbitalia) as a method for distinguishing between scurvy and anemia in subadult crania. Computed Tomography (CT) was used to measure CVT at various landmarks associated with porotic hyperostosis and cribra orbitalia, complemented by lesion scores, from scorbutic (N = 11), anemic (N = 3), and non-pathological (N = 28) subadult crania used as a control group. Results indicate that CVT consistently distinguishes scorbutic from non-pathological individuals, while anemic individuals overlap with both likely a function of small sample size in this study. Despite current limitations, CVT has the potential to be an objective diagnostic tool for distinguishing scurvy and expanding reconstructions of nutritional adequacy over the life course in past populations.