Radiographically recognizable? An investigation into the appearance of osteomalacic pseudofractures

Abstract

Pseudofractures, lucent bands that occur due to a build-up of osteoid, are a key feature of osteomalacia. In paleopathology, pseudofractures are often marked by small, linear cracks in the cortex of the bone surrounded by irregular, bony spicule formation. Radiography can be used to help diagnose pseudofractures, both clinically and in paleopathology. A detailed understanding of the radiographic appearance of pseudofractures and their development is, therefore, necessary to aid a diagnosis of vitamin D deficiency. The present study examined the clinical literature to determine current ideas on the appearance of pseudofractures with the aim of applying this knowledge to paleopathology. A radiographic study of the characteristics of pseudofractures was performed on five individuals with clear skeletal features of osteomalacia from archaeological sites in Canada and the United Kingdom dating to the medieval period (5 th to 15 th centuries) and the 19 th century. Results show that the radiographic appearance of pseudofractures could potentially reveal information about the cause of the deficiency and the chronicity of pseudofractures. This type of information has the potential to further our understanding of the lived experiences of archaeological individuals with osteomalacia.

Commentary: Pathological fractures in osteomalacia, an underrecognized phenomenon

“…The radiographic appearance of pseudofractures, and the fact that some lesions are not recognized, was investigated by Jennings et al (2018). Radiographically recognizable cases probably represent lesions of greater chronicity arising from acquired deficiency states (i.e., nutritional, malabsorptive, or renal) (Jennings et al, 2018).…”

“…The radiographic appearance of pseudofractures, and the fact that some lesions are not recognized, was investigated by Jennings et al (2018). Radiographically recognizable cases probably represent lesions of greater chronicity arising from acquired deficiency states (i.e., nutritional, malabsorptive, or renal) (Jennings et al, 2018). At the individual level, identification of pseudofractures and careful assessment of characteristics indicative of chronicity will contribute to understanding of the lived experience of past community members (see Brickley et al, 2020, p. Box 8‐1; Jennings et al, 2018).…”

“…Radiographically recognizable cases probably represent lesions of greater chronicity arising from acquired deficiency states (i.e., nutritional, malabsorptive, or renal) (Jennings et al, 2018). At the individual level, identification of pseudofractures and careful assessment of characteristics indicative of chronicity will contribute to understanding of the lived experience of past community members (see Brickley et al, 2020, p. Box 8‐1; Jennings et al, 2018). The presence of two fractures in the case presented by Darton (2010), one showing sclerotic areas on radiographs, provides some information on the underlying cause and chronicity.…”

“…Various terms have been used to describe pathological fractures occurring in osteomalacia, and pseudofracture has been widely used (see discussion in Jennings et al, 2018). These fractures play a key role in diagnosis of osteomalacia in archaeological skeletal material (Brickley et al, 2018).…”

“…In most cases of osteomalacia reported in both paleopathology (i.e., nutritional, malabsorptive, or renal) (Jennings et al, 2018). At the individual level, identification of pseudofractures and careful assessment of characteristics indicative of chronicity will contribute to understanding of the lived experience of past community members (see Brickley et al, 2020, p. Box 8-1;Jennings et al, 2018).…”