The bare bones appearance of hyperparathyroidism: Distinguishing subperiosteal bone resorption from periosteal reaction

Abstract

AbstractThree types of resorption (endosteal, intracortical [Haversian], and periosteal envelope [subperiosteal]) have been observed in hyperparathyroidism. The current manuscript addresses the one manifestation that seems to have specificity, subperiosteal bone resorption, and allows us to distinguish the resultant subperiosteal resorption from the unrelated accretion phenomenon, periosteal reaction. Skeletons of 2906 individuals in the Hamann‐Todd Human Skeletal Collection were visually (macroscopically) examined to identify surface resorption and tuft alterations. Surface resorption was present bilaterally in 18 of 94 individuals with renal disease‐derived hyperparathyroidism, but absent in the other 2812 individuals examined. Manual tuft resorption was present in four individuals with hyperparathyroidism and absent in all others examined. Given its limitation to individuals with known hyperparathyroidism, the presence of subperiosteal resorption appears diagnostic. The 4% prevalence of subperiosteal reaction in the Hamman‐Todd cohort with hyperparathyroidism is indistinguishable from that reported in clinical samples. Subperiosteal resorption appears be a phenomenon in the archeological record that is pathognomonic for the diagnosis of hyperparathyroidism. Such biologically remodeled bone is easily distinguished from post‐mortem damage and its position subjacent to the periosteum facilitates distinguishing it from periosteal reaction. While the presence of subperiosteal bone resorption appears to have great specificity, its sensitivity is low as it was found only in 19% of individuals examined in this study.