Correspondence

Osteoporosis 4000 Years Ago

N Engl J Med 1996; 334:735March 14, 1996

Article

To the Editor:

Frigo and Lang (Nov. 30 issue)1 describe an ancient skeleton of a 45-year-old woman as osteoporotic on the basis of the bone mineral density at the femoral neck (0.831 g per square centimeter). This value, however, was only 1 SD below the average value for bone mineral density in 14 skeletons of women of a similar age at the same site (0.981±0.148 g per square centimeter). Because these women died at a relatively young age, the value of 0.981 g per square centimeter can be regarded as close to the peak value for bone density.

A World Health Organization study group has defined osteoporosis as a value for bone mineral density that is 2.5 SD or more below the value in young adults.2 A value within 1 SD of the reference value in young adults is considered to be normal, and a value between 1 and 2.5 SD below the reference value indicates osteopenia. Thus, the bone mineral density of the skeleton described by Frigo and Lang represents normal bone mass or borderline osteopenia at most, but not osteoporosis.

We recently reported on an ancient female skeleton of a similar age with extreme osteoporosis documented by radiologic, densitometric, and histomorphometric methods.3 There was an overt collapse of two thoracic vertebrae, and the values for bone mineral density at different sites were 5 to 8 SD below the mean values in young adults. The bone mineral density at the femoral neck was only 0.359 g per square centimeter, as compared with 0.944 g per square centimeter in a control female skeleton.

A. Joseph Foldes, M.D.
Mordecai M. Popovtzer, M.D.
Hadassah University Hospital, Jerusalem 91007, Israel

3 References

1. 1

   Frigo P, Lang C. Osteoporosis in a woman of the early Bronze Age. N Engl J Med 1995;333:1468-1468
   Full Text | Web of Science | Medline

2. 2

   WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Tech Rep Ser 1994;843:1-129
   Web of Science | Medline

3. 3

   Foldes AJ, Moscovici A, Popovtzer MM, Mogle P, Urman D, Zias J. Extreme osteoporosis in a sixth century skeleton from the Negev desert. Int J Osteoarchaeol 1995;5:157-162
   CrossRef | Web of Science

Author/Editor Response

The authors reply:

To the Editor: Foldes and Popovtzer question the presence of osteoporosis in the female skeleton we described. We would like to clarify the issue as follows.

Four thousand years ago, 45 years must have been a fairly advanced age. In our group of skeletons, the mean age of the women at the time of death was 34±12 years (mean age among the men, 39±12 years). It can be assumed that the peak bone mass at the femoral neck occurred at a much earlier age (around 20 years) than it does today (between 20 and 25 years1,2). In the skeleton we described, the bone mineral density was more than 1 SD below the mean (<0.833 g per square centimeter). Moreover, in our group of skeletons, the mean bone mass in women who were approximately 20 years old was about 1.2 g per square centimeter. Hence, the woman we described probably had osteoporosis, defined as a value for bone mineral density that is 2.5 SD or more below the mean value in young adults.

Foldes and Popovtzer describe a case of osteoporosis in a female skeleton that was approximately 1400 years old. Their description of this skeleton, which they examined, seems to confirm our hypothesis that women had lower bone density than men even several thousand years ago.

Because postmortem changes occur in skeletal material3 (e.g., calcific deposits), the data on bone mineral density can be compared only within a group of skeletons and only if the persons in the group were buried within a limited period (about 150 years in the case of the skeletons at Unterhautzental, Austria). Moreover, the depth of burial and the ground conditions should be fairly uniform. Provided these conditions are met, it is possible to achieve accurate results, such as those we obtained on examining the skeletons at Unterhautzental.

Peter Frigo, M.D.
Christine Lang, M.D.
Johannes C. Huber, M.D., Ph.D.
Vienna University Hospital, A-1090 Vienna, Austria

3 References

1. 1

   Laitinen K, Valimaki M, Keto P. Bone mineral density measured by dual-energy X-ray absorptiometry in healthy Finnish women. Calcif Tissue Int 1991;48:224-231
   CrossRef | Web of Science | Medline

2. 2

   Steinberg KK. Women's health: osteoporosis: introductory remarks. Public Health Rep 1987;102:Suppl:125-127
   Medline

3. 3

   Kneissel M, Boyde A, Hahn M, Teschler-Nicola M, Kalchhauser G, Plenk H Jr. Age- and sex-dependent cancellous bone changes in a 4000y Bp population. Bone 1994;15:539-545
   CrossRef | Web of Science | Medline