A paleoepidemiological approach to the osteological paradox: Investigating stress, frailty and resilience through cribra orbitalia

Abstract

Objectives The Osteological Paradox posits that skeletal lesions may differentially be interpreted as representing resilience or frailty. However, specific consideration of the etiologies and demographic distributions of individual skeletal indicators can inform the criteria on which to differentiate stress, frailty, and resilience. Adopting a life history approach and adaptive plasticity model, this study proposes a framework for the analysis and interpretation of a commonly reported skeletal lesion, cribra orbitalia, which considers the underlying mechanisms of the condition, the clinical and epidemiological literature relating to anemia and malnutrition, and the bioarcheological evidence. Materials and methods Data were extracted from the European (n = 33 populations) and American (n = 19 populations) modules of the Global History of Health Project. Kaplan–Meier and Cox regression analyses were applied, where time was the age‐at‐death, and the factor or covariate was presence or absence of cribra orbitalia. Results Of 37 samples that produced significant results, 21 demonstrated a change in relationship when the subadults were excluded from analysis. When subadults were included, individuals with cribra orbitalia present had statistically significant lower survival time. With subadults excluded, the relationship either became nonsignificant or was reversed. Discussion We demonstrate that in many cases the inclusion of subadults in analysis impacts upon the apparent mortality associated with cribra orbitalia. Examining cribra orbitalia in children and adults has two separate goals: in children, to determine the prevalence and risk of death associated with active lesions and stress; and in adults, to determine whether childhood health assaults that cause cribra orbitalia are associated with frailty or resilience.

Extirpating Inherently Biased Rote Approaches, Replacing them with Critical Thinking-Based Interpretation of Evidence

“…Assumption of the association of cribra orbitalia with anemia [40][41][42][43][44][45][46][47], based on a speculative relationship to porotic hyperostosis, is one such example This is especially egregious given lack of correlation of the two phenomena (cribra orbitalia and porotic hyperostosis [48,49].…”

“…The consensus that has been achieved as to the elements "remained mostly irrelevant both to understanding carcinogenesis and to significantly benefiting the object of the whole effort, the cancer patient. There is a misunderstanding of the basic biological phenomenon, analogous to that concerning the relationship of porotic hyperostosis to iron deficiency anemia [40][41][42][43][44][45][46][47]49].…”

Using a multimethod life history approach to navigate the osteological paradox: A case study from Prehispanic Nasca, Peru

“…Despite the clear overarching ramifications of the osteological paradox and the development of viable theoretical and methodological tools to address it (Baker & Agarwal, 2017), a 2015 literature review by DeWitte and Stojanowski shows that the majority of articles with paleopathological data cite the osteological paradox but rarely engage with it in a meaningful way. However, recent years have seen a rise in scholarship committed to explicitly engaging the paradox (Garland, 2020;Kyle et al, 2018;Marklein et al, 2016;McFadden & Oxenham, 2020;Novak et al, 2017;O'Donnell, 2019;Smith & Littleton, 2019;Spake et al, 2021;Stull et al, 2020;Temple, 2019) through the use of survival analysis, multi-method approaches, and a focus on mortuary contexts with tight temporal or demographic controls. Additional bioarchaeological research that addresses the issues of the osteological paradox in various contexts is needed in order to gain better understanding of past population health in specific settings and to determine under what conditions "paradoxical" interpretations are most likely to be correct.…”

“…Because skeletal tissue is relatively slow to respond to stimuli, a skeletal lesion evinces a minimum threshold of individual robustness, and therefore it is entirely possible that in some contexts “better health makes for worse skeletons” (Wood et al, 1992, p. 356). Recent research has addressed this quandary using life history theory (DeWitte & Stojanowski, 2015; Gowland, 2015; Klaus, 2014; McFadden & Oxenham, 2020; Steckel, 2005; Temple, 2019). The life history approach, which we adopt here following Temple (2019), focuses on understanding the relationship between stress, skeletal plasticity, and physiological constraint.…”

Social differentiation and well-being in the Italian Iron Age: exploring the relationship between sex, age, biological stress, and burial complexity among the Picenes of Novilara (8th–7th c. BC)

“…Heterogeneity in disease risk, selective mortality, and demographic non-stationarity adds to these issues (Wood et al 1992). Different publications have addressed these problems, leading to new or revised theoretical and methodological approaches (e.g., Laffranchi et al 2019;McFadden and Oxenham 2020;Pechenkina and Delgado 2006;Sparacello et al 2015). The recognition of the multifaceted nature of social status and health, in particular, has suggested the suitability of a nuanced approach to these studies (Robb 1997) and the suitability of multivariate methods for testing biocultural hypotheses (Laffranchi et al 2019;Pechenkina and Delgado 2006;Sorrentino et al 2018).…”