The causes of porotic hyperostosis and cribra orbitalia: A reappraisal of the iron‐deficiency‐anemia hypothesis
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- 11 March 2009
- journal article
- review article
- Published by Wiley in American Journal of Physical Anthropology
- Vol. 139 (2), 109-125
- https://doi.org/10.1002/ajpa.21031
Abstract
Porosities in the outer table of the cranial vault (porotic hyperostosis) and orbital roof (cribra orbitalia) are among the most frequent pathological lesions seen in ancient human skeletal collections. Since the 1950s, chronic iron‐deficiency anemia has been widely accepted as the probable cause of both conditions. Based on this proposed etiology, bioarchaeologists use the prevalence of these conditions to infer living conditions conducive to dietary iron deficiency, iron malabsorption, and iron loss from both diarrheal disease and intestinal parasites in earlier human populations. This iron‐deficiency‐anemia hypothesis is inconsistent with recent hematological research that shows iron deficiency per se cannot sustain the massive red blood cell production that causes the marrow expansion responsible for these lesions. Several lines of evidence suggest that the accelerated loss and compensatory over‐production of red blood cells seen in hemolytic and megaloblastic anemias is the most likely proximate cause of porotic hyperostosis. Although cranial vault and orbital roof porosities are sometimes conflated under the term porotic hyperostosis, paleopathological and clinical evidence suggests they often have different etiologies. Reconsidering the etiology of these skeletal conditions has important implications for current interpretations of malnutrition and infectious disease in earlier human populations. Am J Phys Anthropol 2009.Keywords
This publication has 105 references indexed in Scilit:
- Vitamin B12 deficiency in infancy as a cause of developmental regressionBrain & Development, 2005
- Anemia and childhood mortality: Latitudinal patterning along the coast of pre-Columbian PeruAmerican Journal of Physical Anthropology, 2005
- Long-term neurologic consequences of nutritional vitamin B12 deficiency in infantsThe Journal of Pediatrics, 1992
- Prehistoric human impact on the environment in the upland North American SouthwestPopulation and Environment, 1992
- Nutritional beliefs among rural Nigerian mothersEcology of Food and Nutrition, 1988
- Porotic hyperostosis: Representative of a childhood conditionAmerican Journal of Physical Anthropology, 1985
- Erythrocyte membrane lipid peroxidation in iron deficiency anemiaCellular and Molecular Life Sciences, 1984
- Modeling the long-term effects of fuelwood harvests on Pinyon-Juniper WoodlandsEnvironmental Management, 1982
- A Syndrome of Methylmalonic Aciduria, Homocystinuria, Megaloblastic Anemia and Neurologic Abnormalities in a Vitamin B12-Deficient Breast-Fed Infant of a Strict VegetarianThe New England Journal of Medicine, 1978
- Bahima disease: Possible “milk anemia” in late childhoodThe Journal of Pediatrics, 1962