Vertebral Osteophytosis Research Articles

7002 Building Poor Bone, A Rare Presentation Of Skeletal Fluorosis

Abstract Disclosure: C. Pham: None. J.S. Lopresti: None. Skeletal fluorosis is a rare disease associated with osteosclerosis and fractures. Case: 26 year old male presented with a history of multiple traumatic fractures but no childhood or family history of fractures. Initial labs revealed a corrected calcium of 8.1 mg/dL (8.5-10.3), ALP 1,504 U/L (40-129), PTH 131 pg/ml (15-65), 25-OH D 14 ng/ml (30-100), PO4 3.7 mg/dl (2.5-4.5) and normal creatinine. X-Rays demonstrated osteosclerosis and cortical expansion of bone and nuclear bone scan demonstrated diffuse increased uptake. Further history revealed huffing of computer inhalants (10 cans daily) for years. Due to these findings, urine fluoride 16.88 mg/L (0.20-3.20 mg/L) and serum fluoride 0.40 mg/L (<0.05 mg/L) were obtained and vitamin D was started. 4 months later, his vitamin D level improved to 21 while calcium levels normalized despite ongoing inhalant use. ALP (878) and PTH (92) continued to be elevated albeit at improved levels. Conclusion: Exposure to fluoride leads to a rare condition called skeletal fluorosis causing accelerated osteogenesis and bone turnover leading to weak bone. Symptoms include bony pain, fractures, and osteosclerosis on radiographs. Differential diagnosis includes other conditions associated with osteosclerosis such as Paget’s disease and myelofibrosis. However, diffuse osteosclerosis and vertebral osteophytosis are noted only in skeletal fluorosis compared to other potential causes, though our patient did not have a CT spine done to assess for osteophytes. Biochemical studies can include hypocalcemia and hyperparathyroidism. It is thought that low calcium intake contributes to the hyperparathyroidism. Elevated serum and urine fluoride levels are also diagnostic and can persist for months after cessation of fluoride intake. Sodium fluoride has been posited as a treatment for osteoporosis due to its tremendous ability to build bone; however, the quality of bone made is poor leading to unacceptable fracture rates. Skeletal fluorosis should be suspected in any patient with history of diffuse osteosclerosis and hyperparathyroidism; and vitamin D supplementation should be initiated. In our case, hypocalcemia and PTH levels were improved despite active inhalant use after vitamin D supplementation. This suggests that Vitamin D deficiency and fluoride may be two independent driving factors in hyperparathyroidism in patients with fluorosis. Increased calcium absorption with vitamin D provides therapeutic benefit in both cases. Presentation: 6/1/2024

Economic access influences degenerative spine disease outcomes at rural Late Medieval Villamagna (Lazio, IT).

Degenerative joint disease in the spine is heavily influenced by genetic, environmental, and epigenetic factors, as well as exacerbated by physical activity and injury. The objective of this study was to investigate the multivariate relationship between known predictors of degenerative joint disease in the spine, such as age and sex, with mortuary indicators of economic access such as grave inclusions, burial location, and burial type. The presence and severity of vertebral osteophytosis (VO) and vertebral osteoarthritis (VOA) was recorded for the vertebral columns of N = 106 adult individuals from the Late Medieval period at the rural monastery of San Pietro at Villamagna in Lazio, Italy (1300-1450 AD). Multiple skeletal indicators of degenerative joint disease, morphological sex, and age were compared with differences in mortuary treatment across four regions of the spine. There are marked differences in severe joint disease outcome between groups with more and less economic access. Relative risk ratios suggest that males and females with less economic access have elevated risk for VO and VOA in specific spine regions, although this effect is reduced among females. Current research on the consequences of economic and social inequality point to the important role of economic inequality in shaping disease outcomes. Our results suggest that biocultural effects of reduced economic access at the intraclass level may increase vulnerability to the downstream effects of risk exposure (e.g., biomechanical injure, physical activity, biochemical imbalance), and ultimately increase the risk and prevalence for severe degenerative disease outcomes in medieval Italy.

Paleopathological Research in Southern Patagonia: An Approach to Understanding Stress and Disease in Hunter-Gatherer Populations

This article reviews the most relevant data regarding evidence of stress and disease in native populations from Southern Patagonia and proposes future directions for paleopathological research. It focuses on the disease patterns in hunter-gatherer societies and the changes produced by contact and colonization. Studies of oral pathologies show a high frequency of dental attrition and low frequency of caries and antemortem tooth loss. Individuals with terrestrial dietary patterns show evidence of higher mechanical stress in the spine than those who participated in marine economies, based on the prevalence of Schmorl's nodes and vertebral osteophytosis. Porotic hyperostosis is more prevalent in individuals who had a marine diet and is probably related to nutritional impairment and parasitic infections. A higher frequency of metabolic stress was identified in individuals who lived in missions, perhaps because of declining quality in diet, hygiene, and living conditions. Paleoparasitological studies identified several species of parasites associated with human skeletons and terrestrial fauna. Moreover, recent studies suggested that treponematosis and tuberculosis were present in Patagonia since at least 1000 years BP. Future paleopathological research should increase the size and quality of studied samples and apply new methods and interpretive criteria. Detailed research into infections, degenerative joint diseases, and trauma (including violence episodes) has rarely been conducted.

OSTEOFITOSIS VERTEBRAL EN POBLACIONES PREHISPÁNICAS DE SAN PEDRO DE ATACAMA, NORTE DE CHILE

Vertebral osteophytosis was studied as a marker for physical stress in prehistoric populations of San Pedro de Atacama from the Middle (400 – 1.000 A.D.) and Late Intermediate (1.000 – 1.450 A.D.) periods. The mean degree of osteophytosis was recorded in each vertebral segment of 154 individuals from four sites: Solcor 3, Coyo 3, Quitor 6 and Toconao Oriente. Osteophytosis prevalence was more severe in older individuals, corroborating its degenerative nature. However, after correction for age impact in osteophytosis prevalence, significant differences were observed between sites. Differences in osteophytosis prevalence between sexes were not significant. The results show that during the Late Intermediate period populations of both sexes suffered less vertebral stress than during the Middle period, particularly during the its end. Changes in activity patterns (amount of energy invested, intensity or type of activities undertaken) could account for the differences found.

Is vertebral body osteophytosis a reliable indicator of occupational stress?

Whether activity patterns cause vertebral body osteophytosis (VO) remains unanswered. Although, many previous researchers indicate physical activity as an etiological factor of VO, a number of recent studies have questioned this conclusion. Thus, using a sample of 101 adult males from medieval Poland, this current study examines whether individuals with VO have greater entheseal change (EC) scores since EC are commonly used as an indicator of activity. The sample was divided into younger adults (20 to 40 years old) and older adults (41 to 56 years old). Three aggregate variables (aggregate VO, upper limb ECs, and lower limb ECs) were created to determine whether VO may be useful in activity pattern reconstructions. No significant age differences were found and, thus, all correlations were run without age controls. A significant positive correlation was found between aggregate VO and lower limb EC (rho = 0.347, p < 0.01). The existence of the correlation between aggregate VO and lower limb EC in this study implies that vertebral osteophytosis may relate to occupational stresses and there may be similar etiologies present in VO and EC formation, but there remains much unexplained variance that suggests that VO and EC etiologies are complex.

Vertebral osteophyte of pre-modern Korean skeletons from Joseon tombs

Spinal osteophytic changes are known to be affected by differences in age, sex, population, and mechanical stress. We examined Joseon skeletons (n=87) to obtain vertebral osteophytosis data on a pre-modern Korean population. The mean osteophytic value (MOV) of vertebrae increased in the cervical-thoracic-lumbar order. More severe osteophytosis was found in the vertebrae (C5, T9, T10, and L4) farthest from the line of gravity, while the general pattern of vertebral osteophytosis appeared similar to those of previous reports on other skeletal series. More severe osteophytes were much more common in the males, possibly due to their engaging in more strenuous physical labor than that of females. We also observed MOV patterns seemingly unique to the Joseon people, and findings not typically reported in previous studies. Although a full explanation of the factors contributing to vertebral-osteophytic development in Joseon Koreans will require further studies, the present results are meaningful to anatomists and anthropologists interested in osteophytic patterns occurring in an East Asian population.

Measuring and interpreting age‐related loss of vertebral bone mineral density in a medieval population

This study investigates the age- and sex-related patterns in vertebral bone mineral density (BMD) and the relationship between BMD and vertebral osteophytosis (VO), using a specialized peripheral densitometer in a skeletal sample excavated from the British medieval village Wharram Percy. A total of 58 individuals were divided by sex into three broad age categories (18-29, 30-49, 50+ years.). Each fourth intact vertebral centra was scored for VO and 5-mm thick coronal sections scanned in a specialized peripheral densitometer (GE Lunar Piximus DXA). Changes in BMD associated with age, sex, and VO severity were examined in the whole vertebral section, a strictly trabecular region, and a primarily cortical region of bone separately. Significant change in vertebral BMD was found to occur by middle age with little or no statistical change in BMD between middle and old age. Females appear to suffer greater bone loss at an earlier age with no change in BMD between middle and old age, whereas males show a more steady loss of BMD across the age groups. The bone mineral content and BMD of the cortical region is higher in individuals with pronounced/severe osteophytosis. The unusual age- and sex-related patterns of change in vertebral BMD at Wharram Percy are compared with the patterns of age-related change from recent longitudinal population-based studies. The results emphasize the different pattern of bone loss in young adulthood seen in trabecular regions of the skeleton and highlight the importance of consideration of degenerative joint disease in BMD studies. The influence of lifestyle factors on vertebral BMD in this medieval population is also discussed.

Schmorl's nodes in a post‐medieval skeletal sample from Klostermarienberg, Austria

AbstractThe prevalence and distribution pattern of Schmorl's nodes (SNs) were studied in a post‐medieval skeletal sample (n = 473) from the 16th–18thcentury cemetery of Klostermarienberg, Austria. The reasons for the prevalence and distribution pattern of SNs in this sample are discussed with regard to their aetiology. SNs were correlated with age and sex as well as with degenerative spinal joint disease such as vertebral osteophytosis (VO) and apophyseal osteoarthritis (OA). SNs were most commonly found in the lower thoracic region, in agreement with other studies. Males were more affected than females by SNs, especially in the lower thoracic region. SNs show a completely different distribution pattern to VO and OA. Additionally, there was no relationship found between SNs and ageing. Observed differences in the prevalence of SNs in the vertebral column and between the sexes suggest that mechanical factors may be responsible. Copyright © 2008 John Wiley &amp; Sons, Ltd.

Uncovering a nineteenth-century typhoid epidemic at the Koffiefontein Mine, South Africa

Thirty-six skeletons were excavated in a mine dump at the Koffiefontein Mine in South Africa. Archival documents revealed that these individuals had been mine workers who died during a typhoid epidemic in 1896. Archaeological evidence for an epidemic was noted in the place and mode of burial, which suggested haste and uncoordinated efforts. Various pathologies were noted on the skeletal remains, the most common of which were vertebral osteophytosis, intervertebral osteochondrosis, schmorl nodes, and enamel hypoplasias. Unusual lesions were noted on the lumbar vertebrae of three individuals but the aetiology behind these lesions is not known.

Petra North Ridge Tombs 1 and 2: Preliminary Report

In 1998-99, two Nabataean tombs were excavated in Petra. One contained intact burials that provide insight into the lives of one extended family: they led healthy, active lives, with few signs of stress or bony responses to chronic diseases, but fractures and other injuries show that they were occasionally prone to nonfatal falls. With age, they experienced degenerative conditions, such as degenerative joint disease (DJD) and vertebral osteophytosis. The individuals were buried during a short period of time with some interred simultaneously, but there were no signs of a shared traumatic event in the skeletal remains. Although the tombs were disturbed in antiquity, they yielded quantities of ceramics. These indicate that the tombs are from successive but overlapping time periods, and belong, in general, to the first century A. D. Comparison of the two groups gives insight into the development of Nabataean ceramics and places some of the well-known painted pottery into a context that includes the much more numerous plain wares.

The Position and Shape of Osteophyte Formations at Canine Vertebral Endplates and its Influence on Radiographic Diagnosis

The relationship between the risk of missing osteophytes in lateral radiographs and their position was determined in a sample of German shepherd dogs (GSDs, n = 42) and dachshunds (DHs, n = 36). Only 10% of osteophytes which were not detected on radiographs were located in the ventral median area (position 1) and classified as type 1 (small spur with narrow base). The highest risk for being affected next to the intervertebral foramen and/or the dorsal area of the vertebral endplate (position 3) was noticed in the lumbar segment (95% CI: 5.2-9.8% in DHs; 11.9-17.7% in GSDs). The minimum risk of missing osteophytes in this position radiologically was 33.3% in the GSDs and 26.4% in the DHs. In the GSDs a higher proportion of type 2 osteophytes (spur with broader base of origin, tending to extend up to half the way along the disc space) was not visualized on radiographs. Peak incidences of osteophytes in positions 1 and 3 were located at the centres of spinal flexion and extension. Therefore, distribution patterns of osteophytes in these positions confirmed mechanical factors being important in pathogenesis of vertebral osteophytosis.

Lumbar osteoarthritis, bone mineral density, and quantitative ultrasound.

Low bone mass is a major risk factor for osteoporotic fractures. Thus, bone density evaluation, performed by Dual Energy X-ray Absorptiometry (DXA) is important for diagnosis and monitoring treatment of osteoporosis. The accuracy of DXA, particularly at the lumbar spine, can be affected by several factors such as degenerative diseases. To evaluate the effects of vertebral osteophytosis on densitometric measurements, we examined 198 women, aged 32-81 years, who had undergone lateral X-ray of the lumbar spine. We classified patients according to different grades of osteophytosis, and evaluated bone density at the lumbar spine and the proximal femur by DXA. We also performed quantitative ultrasound at the heel (QUS). Patients with severe osteophytosis were significantly older (p < 0.0005), and values were adjusted for this parameter. We observed a significant increase in lumbar bone density with worsening osteophytosis (p < 0.02). On the contrary, no significant differences were found at the femur and QUS. According to bone density at the femoral neck, we subdivided patients into two groups: osteoporotic (group A) and non-osteoporotic (group B). Both groups showed increasingly high bone density at the spine with worsening osteophytosis (A: p < 0.01; B: p < 0.02). No differences were found in all the other evaluations. In conclusion, lumbar spine measurement is dramatically influenced by osteophytosis, particularly in the elderly. Consequently, other strategies should be performed such as evaluation of the hip and also measurement of the heel by ultrasound, which could be an interesting approach in these cases.

Degenerative joint disease in African great apes: an evolutionary perspective

Degenerative joint disease is investigated in the spine and major peripheral joints (shoulder, elbow, hip and knee) in samples of chimpanzees (Pan troglodytes schweinfurthii; P. troglodytes troglodytes), lowland gorillas (Gorilla gorilla gorilla), and bonobos (P. paniscus). The P. troglodytes schweinfurthii sample comes from Gombe National Park, Tanzania, while the other samples are derived from museum materials originally collected in west/central Africa. Total data for African ape samples include 5807 surfaces for ascertainment of vertebral osteophytosis, 12,479 surfaces for determination of spinal osteoarthritis, and 1211 joints for evaluation of peripheral joint osteoarthritis. All apes display significantly less spinal disease than in a comparable human sample, and these differences are most likely a consequence of human biomechanical adaptations for bipedal locomotion. Apes are also generally less involved in the major peripheral joints than are humans, but human groups are themselves highly variable in prevalence of peripheral osteoarthritis. These data agree with other findings of low prevalence of degenerative joint prevalence in free-ranging apes, but contrast markedly with evidence derived from colony-reared Old World monkeys.

The pattern of spondylosis deformans in prehistoric samples from west-central New Mexico

A Pre-Columbian skeletal sample (n=42) from two ancestral Pueblo sites in the Rio Grande valley of west-central New Mexico was examined for frequency and severity of spondylosis deformans (vertebral osteophytosis). No significant sex differences were detected. Degenerative changes in the collective sample are generally confined to no more than well-defined horizontal lipping at the joint margins. Advanced proliferative osteophytic change is infrequent even in the oldest age category. Not surprisingly, the lumbar vertebrae were the most frequently and most severely involved vertebral segment for all three adult age cohorts defined. The cervical vertebrae were the least involved. This pattern generally conforms with observations made on other archaeological samples from west of the Mississippi River, but it contrasts with the general pattern of more extensive cervical involvement in Pre-Columbian North American samples from the Eastern Woodlands. This possible east–west difference is hypothesized (Bridges, P.S. 1994. American Journal of Physical Anthropology 93: 83–93) to be related to differential burden bearing habits. Copyright © 2000 John Wiley & Sons, Ltd.

Vertebral osteophytosis and bone mass at the hip and forearm in elderly women

Vertebral osteophytosis and bone mass at the hip and forearm in elderly women

Skeletal distribution of degenerative changes in vertebral osteophytosis, vertebral osteoarthritis and DISH

AbstractIn order to comprehend the condition of vertebral osteophytosis, vertebral osteoarthritis and DISH (diffuse idiopathic skeletal hyperostosis) with respect to diagnosis and aetiology, the vertebral and peripheral (appendicular) frequency and distribution pattern of degenerative joint changes of 176 rather affluent citizens were analysed from the late medieval city of Dordrecht in Holland. Patterns of frequencies with respect to age and sex were found to be similar essentially to those of a present‐day Dutch suburban village population. Frequencies for vertebral osteophytosis were twice those for vertebral osteoarthritis, and both increased with age in both sexes. The individual pattern of vertebral osteophytosis and vertebral osteoarthritis seems to indicate that each disorder possesses its own progressive identity. From the distribution pattern and frequency of peripheral osteoarthritis it was concluded, with respect to the vulnerability of developing this complication under physically moderate life conditions, that causal factors for vertebral osteophytosis are less important than those for vertebral osteoarthritis. Osteoarthritis presented itself as a systemic disorder, affecting synovial joints in general. Finally it was appreciated that, with increasing age, bony outgrowths from joint degeneration become anatomically masked by para‐articular ossifications from DISH.

Skeletal markers of occupational stress in the Fur Trade: A case study from a Hudson's Bay Company Fur Trade post

AbstractThe Seafort Burial Site (FcPr100) is a Fur Trade Period cemetery located near the town of Rocky Mountain House, Alberta. The results of recent analysis of skeletons recovered during salvage excavations between 1969 and 1971 suggest that three males in this sample were voyageurs in the employ of the Hudson's Bay Company. Vertebral osteophytosis and osteoarthritis, Schmorl's nodes, muscle origin robusticity and new bone formation at entheses and syndesmoses, and osteoarthritis at the elbow and shoulder joints provide evidence for carrying, lifting, and paddling or rowing. The presence of accessory sacral facets also may be stress‐related. In addition, the development of accessory articular facets on the metatarsals and proximal pedal phalanges may indicate activity‐induced stress from hyperdorsiflexion of the toes in habitual kneeling, such as when river canoeing.

Paleoepidemiology of a Central California prehistoric population from CA‐ALA‐329: II. Degenerative disease

Degenerative lesions are scored and frequencies of involvement are computed for a skeletal collection from Ca-Ala-329, a prehistoric site on the southeastern side of San Francisco Bay, dating from 500 A.D. up to European contact. A large earthmound site, excavations conducted there by San Jose State University retrieved close to 300 burials. For this epidemiological analysis, reasonably complete and aged skeletons representing 77 adult females and 90 adult males are available. Degenerative changes are scored macroscopically in an ordinal fashion for the large fibro-cartilagenous joints between adjacent vertebral bodies (vertebral osteophytosis) as well as the small apophyseal articulations of the spine. In addition, in the peripheral skeleton degenerative changes are scored in the temporo-mandibular, shoulder, elbow, hip, and knee joints as well as the small articulations of the hands and feet. The most common degenerative changes in the spine are seen between the vertebral bodies of the lower lumbar region. In the peripheral skeleton the highest involvement of degenerative disease is seen in the hands and feet. Compared to other relevant osteological samples, this group of hunting-gathering California Indians shows more degenerative changes than settled agriculturists (from Pecos Pueblo, New Mexico) but substantially less frequent involvement than in arctic hunters (Alaskan Eskimos).

1990 Volvo Award in Clinical Sciences: Lumbar Spinal Pathology in Cadaveric Material in Relation to History of Back Pain, Occupation, and Physical Loading

The occurrence of symmetric disc degeneration, anular ruptures, end-plate defects, vertebral body osteophytosis, and facet joint osteoarthrosis was examined radiographically and osteologically in 86 male cadavers for whom occupational, physical loading, and back pain histories were obtained from the men's families. History of back pain and the parameters of spinal pathology were related to the highest and lowest degrees of physical loading. In multivariate analyses, history of back injury was related to the occurrence of symmetric disc degeneration, anular ruptures, and vertebral osteophytosis. Symmetric disc degeneration was associated with sedentary work, and vertebral osteophytosis was related to heavy work. History of back pain was related to occupational physical loading after control for the effects of the other covariates. The results indicate that the least pathology stemmed from moderate or mixed physical loading, but the least back pain was associated with sedentary work.

Skeletal changes associated with chronic isotretinoin and etretinate administration.

The skeletal changes associated with systemic retinoid therapy reflect the influence of retinoids on differentiating systems. Although skin is usually the intended target, treatment with retinoids often results in abnormalities of ossification and calcification. The effects of retinoids on bone may be profound and include progressive calcification of ligaments and tendon insertions, premature fusion of epiphyses, modeling abnormalities of long bones, and perhaps osteoporosis. Although it has been known since 1933 that vitamin A cause bone abnormalities, the mechanism of this effect has been elusive. Recent work suggests a possible relationship of the retinoids with several cytokines, which results in enhanced maturation of the preosteoclast. The increasing number of significant bone changes, including posterior lumbar vertebral osteophytosis, make skeletal toxicity the principle risk factor of chronic systemic retinoid therapy.