AbstractRoman Macedonia has been largely neglected by bioarcheological research. As a result, little is known about the imprint of living conditions of that time on the skeletons of its inhabitants, especially those of the lower classes. This paper presents the paleopathological study conducted on a Roman period (1st–4th c. CE) skeletal assemblage from Pontokomi‐Vrysi, a site in the semi‐mountainous region of Eordaea in Upper Macedonia (now in Kozani Prefecture, Greece). The aim is to investigate differences in the frequency of multiple paleopathological conditions in the buried population and to assess whether these are linked to sex‐ or age‐related differences. The study examines cribra orbitalia (CO), porotic hyperostosis (PH), enamel hypoplasia (EH), osteoarthritis (OA), vertebral osteoarthritis (VOA), intervertebral disk disease (IDD), Schmorl's nodes (SNs), trauma (Tr), and lower limb periostitis/periostosis (PO). The results show higher frequencies of OA, IDD, PO, and Tr among males compared with those among females. These results suggest increased male physical hardship, pointing to a possible gender division of labor with the men of the community being mostly responsible for the physically demanding agricultural and animal husbandry activities. Additionally, comparisons of the CO, PH, and EH patterns in adults and nonadults support that, in general, the Pontokomi‐Vrysi community was resilient enough to overcome stress. Overall, these findings make an important contribution to both the bioarcheology and social history of Roman Macedonia and stress the need for more studies that combine historical, archeological (cultural), and bioarcheological data.