Hyperostosis frontalis interna in female historic skeletal populations: Age, sex hormones and the impact of industrialization

Abstract

When recorded consistently, HFI was positively correlated with age and longevity but had also increased among old age females over time. Our results suggest that nulliparity co-occurs with HFI but is not a primary factor in its pathogenesis. Key factors in HFI presence in females are likely to be increased androgens and the dysregulation of insulin and insulin-like growth factor-1.

Comparative Analysis of Femoral Macro- and Micromorphology in Males and Females With and Without Hyperostosis Frontalis Interna: A Cross-Sectional Cadaveric Study

“…Altogether, results confirmed our hypothesis that subjects with HFI (both males and females) would have changes in bone microarchitecture; however, significant changes in bone mineral density and femoral geometry measured by conventional DXA and HSA were not detected. Differences in femoral microarchitecture between subjects with and without HFI were more assuring in females probably because they experience more pronounced bone formation in HFI, also reflected through more severe macroscopic presentation of HFI on the skull bones [1][2][3]17]. The hypothesis regarding the altered sex steroids as etiological factors in HFI formation relies on the effects of these hormones on bone metabolism.…”

“…Hyperostosis frontalis interna (HFI) is an idiopathic condition manifested by the bone formation involving the endocranial surface of the frontal bone [1]. HFI is usually an incidental finding on radiographic imaging of the skulls.…”

“…At the autopsy, it could be seen as a single/multiple nodular or continuous bony overgrowth which affects different percentage of the endocranial surface of the frontal bone, usually restricted to the area between the superior sagittal sinus and the middle meningeal artery. This condition affects both sexes; however, it is more frequently observed in postmenopausal females [1][2][3]. The reported rates are around 20% for females and 5% for males [1][2][3][4].…”

“…Therefore, it would be expected that this is not just a regional phenomenon affecting the skull bones [9], but rather a systemic event having some effect on other skeletal sites as well. Postmenopausal females are most commonly affected by both osteoporosis [10,11] and HFI [1][2][3]. The question remains whether these conditions have some etiological factor in common (e.g., hormonal imbalance), therefore occurring simultaneously, or are they just co-occurring independently.…”

Phenotypes and pathways: Working toward an integrated skeletal biology in biological anthropology

“…Studies centered on the physiological integration of the skeletal system tend to focus predominately on interactions between metabolic and skeletal systems (Brickley, 2018; Devlin, 2015; Ives & Humphrey, 2018; Snoddy et al, 2018), especially in relation to Vitamin D and C homeostasis. New research, however, is engaging with hormonal‐skeletal interactions (Gosman, Stout, & Larsen, 2011; Western & Bekvalac, 2017), and following calls for more interdisciplinary engagement (Klaus, 2014), bioarchaeologists have made strides to bridge osteoimmunology with bioarchaeology (Crespo, Klaes, Switala, & DeWitte, 2017; Rivera & Mirazón Lahr, 2017). Continued work should seek to validate assumptions regarding the physiological pathways that contribute to skeletal phenotypes of interest and explore the whole‐body effects of observed skeletal phenotypes in order to better assess human experience and variation in the past.…”