How Do Drugs Affect the Skeleton? Implications for Forensic Anthropology

Abstract

Forensic anthropologists rely on a number of parameters when analyzing human skeletal remains to assist in the identification of the deceased, predominantly age-at-death, sex, stature, ancestry or population affinity, and any unique identifying features. During the examination of human remains, it is important to be aware that the skeletal features considered when applying anthropological methods may be influenced and modified by a number of factors, and particular to this article, prescription drugs (including medical and non-medical use) and other commonly used drugs. In view of this, this paper aims to review the medical, clinical and pharmacological literature to enable an assessment of those drug groups that as side effects have the potential to have an adverse effect on the skeleton, and explore whether or not they can influence the estimation of age-at-death, sex and other indicators of the biological profile. Moreover, it may be that the observation of certain alterations or inconsistencies in the skeleton may relate to the use of drugs or medication, and this in turn may help narrow down the list of missing persons to which a set of human remains could belong. The information gathered from the clinical and medical literature has been extracted with a forensic anthropological perspective and provides an awareness on how several drugs, such as opioids, cocaine, corticosteroids, non-steroidal anti-inflammatory drugs, alcohol, tobacco and others have notable effects on bone. Through different mechanisms, drugs can alter bone mineral density, causing osteopenia, osteoporosis, increase the risk of fractures, osteonecrosis, and oral changes. Not much has been written on the influence of drugs on the skeleton from the forensic anthropological practitioner perspective; and this review, in spite of its limitations and the requirement of further research, aims to investigate the current knowledge of the possible effects of both prescription and recreational drugs on bones, contributing to providing a better awareness in forensic anthropological practice and assisting in the identification process of the deceased.

Recent Advances in Forensic Anthropological Methods and Research

“…New approaches are illustrated by the article by Procopio, Mein, Starace, Bonicelli, and Williams [ 6 ], which shows that bone proteomics is a well-founded resource with which to identify microbially driven versus extrinsically driven bone diagenesis. Another novel subject is the review by Marquez-Grant and colleagues on the effects of various drugs on the skeleton, including prescription and recreational drugs, that could affect forensic anthropological analyses [ 7 ]. Another new approach by McWhirter and colleagues describes how to accurately individualize skeletons from commingled remains using mesh-to-mesh value comparisons for pair matching skeletal elements [ 8 ].…”

Pharmacological History of Missing Subjects: Perspective of a Correction Factor to Aid in the Study of Bone Remains

“…by also identifying the thickness of facial soft tissues in facial reconstruction [ 8 ]. However, it should be pointed out that the morphological and osteometric data useful in the reconstruction of the biological age of the subject (for example, the degree of maturation of the bones, the modifications of the articular surfaces, the welding of the cranial sutures, the dental development) suffer from many variables related not only to chronologic age and genetic factors, but also to living habits, work activities, eating habits, drugs and any abuse substances taken in life [ 9 ]. These variables can also decisively affect the placement of bone remains in one age class rather than another, compromising their identification.…”

“…In particular, the effect that a given drug therapy produced during life on the skeleton could be obtained not only on the basis of the type and number of drugs taken, but also on the basis of the duration of administration and dosage. Indeed, several drugs are associated with a reduction in bone mineral density and a risk of early osteoporosis [ 9 ]. These include, for example, antipsychotic drugs that can cause hyperprolactinemia [ 22 ], a condition associated with a reduction in bone mass density (BMD) [ 23 ].…”

“…Glucocorticoids, even if administered by os and at low doses (5 mg/day) involve a loss of BMD at 1 year, while this would tend to increase again after about 1 year from cessation when the risk of fracture is reduced [ 26 , 27 , 28 ]. Additionally, the intake of abuse substances, such as amphetamines, can cause a reduction in bone density [ 9 ]. Cocaine—on the basis of the route of administration—can result in lithic bone lesions (such as perforation of the nasal septum, lesions of the palate with oro-nasal fistulas, lesions of the maxillary sinus, etc.)…”

“…Cocaine—on the basis of the route of administration—can result in lithic bone lesions (such as perforation of the nasal septum, lesions of the palate with oro-nasal fistulas, lesions of the maxillary sinus, etc.) which, not usually accompanied by repair with newly formed bone tissue, may direct the forensic anthropologist to the suspicion of bone remains of a person who is a cocaine user [ 9 , 29 ].…”