Evolutionary Perspectives on the Developing Skeleton and Implications for Lifelong Health

Abstract

Osteoporosis is a significant cause of morbidity and mortality in contemporary populations. This common disease of aging results from a state of bone fragility that occurs with low bone mass and loss of bone quality. Osteoporosis is thought to have origins in childhood. During growth and development, there are rapid gains in bone dimensions, mass, and strength. Peak bone mass is attained in young adulthood, well after the cessation of linear growth, and is a major determinant of osteoporosis later in life. Here we discuss the evolutionary implications of osteoporosis as a disease with developmental origins that is shaped by the interaction among genes, behavior, health status, and the environment during the attainment of peak bone mass. Studies of contemporary populations show that growth, body composition, sexual maturation, physical activity, nutritional status, and dietary intake are determinants of childhood bone accretion, and provide context for interpreting bone strength and osteoporosis in skeletal populations. Studies of skeletal populations demonstrate the role of subsistence strategies, social context, and occupation in the development of skeletal strength. Comparisons of contemporary living populations and archeological skeletal populations suggest declines in bone density and strength that have been occurring since the Pleistocene. Aspects of western lifestyles carry implications for optimal peak bone mass attainment and lifelong skeletal health, from increased longevity to circumstances during development such as obesity and sedentism. In light of these considerations, osteoporosis is a disease of contemporary human evolution and evolutionary perspectives provide a key lens for interpreting the changing global patterns of osteoporosis in human health.

Productivity loss associated with physical impairment in a contemporary small-scale subsistence population

“…Fragility fractures resulting from reduced bone strength are relatively rare in bioarchaeological studies (Agarwal 2008;Agarwal and Grynpas 1996), even among the elderly, leading some to conclude that osteoporosis was rare or absent in past populations (but see (Curate et al 2010;Dequeker et al 1997)). This and the fact that agespecific osteoporotic fracture incidence rates appear to be increasing over time in Western populations (Cooper et al 2011) lends support to the notion that osteoporosis is a modern disease (Kralick and Zemel 2020;Lieberman 2013). On the other hand, few if any bioarchaeologists systematically study thoracic vertebral compression fractures.…”

Productivity loss associated with functional disability in a contemporary small-scale subsistence population

“…This and the fact that age-specific osteoporotic fracture incidence rates appear to be increasing over time in Western populations ( Cooper et al, 2011 ) lends support to the notion that osteoporosis is a ‘disease of modernity’ (cf. Kralick and Zemel, 2020 ; Lieberman, 2013 ). However, few if any bio-archaeologists systematically study thoracic vertebral compression fractures, and a paucity of observed fragility fractures in the archaeological record is partly due to biased preservation of skeletal remains.…”

The Polygenic and Monogenic Basis of Paediatric Fractures

“…Peak bone mass has been proposed as the single most important factor that can be intervened to prevent osteoporosis later in life [15]. This is expected, as peak BMD explains considerably more variance than bone loss, for any BMD measurement during late adulthood [15].…”

“…Peak bone mass has been proposed as the single most important factor that can be intervened to prevent osteoporosis later in life [15]. This is expected, as peak BMD explains considerably more variance than bone loss, for any BMD measurement during late adulthood [15]. A simulation study predicted that an increase of 10% in the magnitude of peak bone mass can delay the onset of osteoporosis by 13 years [16].…”