Macroscopic features of scurvy in human skeletal remains: A literature synthesis and diagnostic guide

Abstract

The past two decades have seen a proliferation in bioarchaeological literature on the identification of scurvy, a disease caused by chronic vitamin C deficiency, in ancient human remains. This condition is one of the few nutritional deficiencies that can result in diagnostic osseous lesions. Scurvy is associated with low dietary diversity and its identification in human skeletal remains can provide important contextual information on subsistence strategy, resource allocation, and human‐environmental interactions in past populations. A large and robust methodological body of work on the paleopathology of scurvy exists. However, the diagnostic criteria for this disease employed by bioarchaeologists have not always been uniform. Here we draw from previous research on the skeletal manifestations of scurvy in adult and juvenile human skeletal remains and propose a weighted diagnostic system for its identification that takes into account the pathophysiology of the disease, soft tissue anatomy, and clinical research. Using a sample of individuals from the prehistoric Atacama Desert in Northern Chile, we also provide a practical example of how diagnostic value might be assigned to skeletal lesions of the disease that have not been previously described in the literature.

Advancing the understanding of treponemal disease in the past and present

“…Table lists the skeletal changes typically associated with treponemal infection and their diagnostic weight, expressed as consistent with treponemal infection, strongly indicative of treponemal infection, and pathognomonic. Weighted diagnostic systems have been advanced for other conditions (e.g., scurvy; see Brickley & Ives, ; Snoddy et al, ). The observations in Table form the basis for the suggested approach to recording the presence (and absence) of treponemal disease (a recommended recording form for keying an investigator into these alterations is included in Supporting Information).…”

Interdisciplinary identification of the skeletal remains of Catherine Roberts‐Davies, The first Welsh settler death in Patagonia, Argentina in 1865

“…To deal with this issue, a combination of lesions in different cranial and postcranial skeletal locations was proposed as a more reliable diagnosis method (Brickley et al, 2016;Brickley & Ives, 2008;Brown & Ortner, 2011;Klaus, 2014;Snoddy et al, 2018). In this paper, we followed the diagnosis method proposed by Brickley et al (2016), in which porosity at sites of blood vessels in cranial bones, hyperostosis, and/or periosteal new bone formation in the cranial bones and periosteal new bone formation in long bones is analysed to obtain a "probable," "possible," or "insufficient evidence" diagnosis of scurvy.…”

Role of Vitamin C in Osteoporosis Development and Treatment—A Literature Review

“…Although the symptoms of osteoporosis can already be seen in the skeletons of ancient human beings [8] and the first clinical descriptions appeared in the XIX century, we are still enriching our knowledge about the aetiology of the disease, the cellular mechanisms that govern it, and effective methods of treatment and prevention. Currently available therapeutic interventions in osteoporosis include calcium and vitamin D supplementation, as well as novel antiresorptive drugs such as ibandronate and denosumab.…”

“…The mechanisms linking the diet and bone metabolism have not been fully elucidated. One plausible explanation is the putative buffering effect of acids derived from vegetables and fruits [8,9]. Moreover, numerous epidemiological studies suggested the importance of micronutrients such as ascorbic acid (vitamin C, VC) in protection against bone loss, not only due to their buffering effects [10][11][12].…”

“…Ascorbic acid deficiency leads to a well described set of symptoms known as scurvy. The syndrome includes several bone symptoms: osteolysis, osteonecrosis, bone loss and pathological fractures [8,15,16]. Nowadays not only is antioxidant function of VC suggested, but it has a role as an important mediator in bone metabolism, regulation of gene expression or activation of immune system; enzyme co-factors are known, too [14,17].…”