Morphological assessment of disease and metabolic disorders in a Western Cape skeletal population

Walters, Jacklynn (2016-12)

Thesis (MSc)--Stellenbosch University, 2016

Thesis

ENGLISH ABSTRACT : Amongst others, disease, pathology, metabolic disorders and other traits, can be investigated after death by examination of skeletal remains. The evaluation of lesions resulting from disease and metabolic disorders in the Kirsten Skeletal Collection will allow for a better understanding of the effects of disease on skeletal material and of the social development and adaptation of a 20th century population group who, prior to death, inhabited the Western Cape region. The aim of this research was to describe and evaluate the presentation of skeletal pathology resulting from disease and metabolic disorders in the Kirsten Skeletal Collection at Stellenbosch University. A total number of 300 skeletons were studied. The male to female ratio for the study was 2:1, and the majority derived from the mixed population/Cape Coloured group (n=209). Three different examination methods were used in order to identify traits of diseases or disorders on the skeletal material. Macroscopic evaluation of skeletal material was done by examining each skeletal element under a magnifying lamp. Microscopic analysis was done by using dry bone histological techniques to create bone sections which were examined under a light microscope with POL contrast. Lastly, full body x-rays from each skeleton were taken using the Lodox® Statscan® imaging system and radiographs were examined with the help of a musculoskeletal radiologist. Congenital and acquired malformations occurred in 45.7% (n=137) of skeletons. These included sacralisation (11.9%), lumbarisation (7.3%), spina bifida (14.0%), scoliosis (4.7%), kyphosis (17.0%), and spondylolysis (2.7%). Infectious diseases presented mostly as a periosteal reaction on skeletal elements. Visually recognisable periostitis occurred in 60.7% of skeletons with 29.3% of skeletons showing visceral periosteal rib lesions. Metabolic disorders were observed in 72.0% of skeletons and included porotic hyperostosis (10.7%), cribra orbitalia (35.6%), enamel hypoplasia (43.8%), Harris lines (24.3%) and osteoporosis (41.3%). The males in the study population showed a statistically significantly higher prevalence for cribra orbitalia than the females. Signs observed for degenerative bone disease included vertebral osteophytes (81.0%), peripheral osteophytes (43.0%), Schmorl’s nodes (9.3%), and diffuse idiopathic skeletal hyperostosis (5.7%). Neoplasms were observed in 23.3% of the skeletons examined and included primary benign bone tumours (17.7%), primary malignant bone tumours (1.0%), and secondary skeletal metastases (5.3%). Neoplasms observed showed a similar prevalence as previous studies. Paget’s disease occurred in four skeletons. An important finding in the present study was the high prevalence of periostitis in the mixed population group which was ascribed to a variety of factors including unsanitary living environments, malnutrition, alcohol abuse and lack of effective medical treatment. Pulmonary infections such as tuberculosis (TB) contributed to a high prevalence of visceral rib lesions; however, this study did not find visceral rib lesions to be pathognomonic of TB. The present study also showed metabolic disorders indicating periods of stress throughout life such as malnutrition and infectious diseases. Results on cribra orbitalia (males affected more than females) contradicted previous literature and the iron deficiency anaemia theory, suggesting that other factors contributed to the presentation of cribra orbitalia. To the author’s best knowledge, this was the first in depth study using a combination of three different methods to evaluate disease presentation of a skeletal collection representative of the inhabitants of the Western Cape, therefore, giving a unique interpretation of the health status of this population.

AFRIKAANSE OPSOMMING : Siektes, patologie, metaboliese afwykings en ander toestande kan na dood bestudeer word deur die skeletmateriaal te ondersoek. Die evaluering van beenletsels wat weens siektetoestande en metaboliese versteurings op die skeletmateriaal in die Kirsten Skeletversameling voorkom, sal bydra om die sosiale ontwikkeling en aanpassing van ‘n 20ste eeu populasiegroep wat voor dood in die Wes-Kaap gewoon het, beter te verstaan. Die doel van die navorsing is om die voorkoms van skelet patologie weens siektes en metaboliese versteurings in die Kirsten Skeletversameling by Stellenbosch Universiteit te evalueer en beskryf. ‘n Totaal van 300 skelette is ondersoek. Die verhouding tussen mans en vrouens in die studiepopulasie was 2:1, met die meerderheid van die studiepopulasie wat vanaf die gemengde populasiegroep/Kaapse Kleuringroep afkomstig is (n=209). Drie verskillende metodes is gebruik om die voorkoms van siektes en/of afwykings op die skeletmateriaal te identifiseer. Makroskopiese evaluasie van die skelette is gedoen deur elke skelet element onder ‘n lamp met vergrootglas ondersoek. Mikroskopiese analise van beensnitte is met behulp van droë been histologiese tegnieke voorberei en onder ‘n ligmikroskoop met POL kontras ondersoek. Laastens, is heelliggaam x-strale van elke skelet geneem met die Lodox® Statscan® beeldingstelsel, en radiografiese opnames is met die hulp van ‘n muskuloskeletale radioloog bestudeer. Aangebore - en verworwe abnormaliteite het in 45.7% (n=137) van skelette voorgekom. Dit het ingesluit sakralisasie (11.9%), lumbalisasie (7.2%), spina bifida (14.0%), skoliose (4.7%), kifose (17.0%), en spondilolise (2.7%). Die effek van infektiewe siektes kon meestal as ‘n periostale reaksie op die skelet waargeneem word. Visueel waarneembare periostitis het in 60.7% van die skelette voorgekom, en 29.3% het visserale periostale ribletsels getoon. Letsels weens metaboliese afwykings is in 72.0% van skelette waargeneem en het porotiese hiperostose (10.7%), cribra orbitalia (35.6%), emalje hipoplasie (43.8%), Harris se lyne (24.3%) en osteoporose (41.3%) ingesluit. Mans in die studiepopulasie het ‘n statisties beduidende hoër voorkoms van cribra orbitalia as die vrouens getoon. Tekens van degeneratiewe beensiektes wat waargeneem is het vertebrale osteofiete (81.0%), perifere osteofiete (43.0%), Schmorl se nodes (9.3%) en diffuse idiopatiese skeletale hiperostose (5.7%) ingesluit. Neoplasmas is in 23.33% van skelette wat ondersoek is waargeneem en het primêre nie-kwaadaardige gewasse (17.7%), primêre kwaadaardige gewasse (1.0%) en sekondêre skeletuitsaaings (5.3%) ingesluit. ‘n Soortgelyke voorkoms soos aangedui in vorige studies, is waargeneem vir neoplasmas. Paget se siekte is in vier skelette ge-identifiseer. ‘n Belangrike ontdekking van die huidige studie was die hoë voorkoms van periostitis in die gemengde populasie groep wat toegeskryf was aan verskeie faktore insluitend onhigiëniese lewensomstandighede, wanvoeding, alkohol misbruik en ‘n tekort aan effektiewe mediese behandeling. Pulmonale infeksies soos tuberkulose (TB) het tot die hoë voorkoms van viserale ribletsels bygedra, alhoewel hierdie studie nie viserale ribletsels as kenmerkend van TB gevind het nie. Die huidige studie het ook metaboliese afwykings getoon wat dui op stres tydperke tydens lewe soos wanvoeding en aansteeklike siektes. Die resultate van cribra orbitalia (mans meer as vrouens beïnvloed) weerspreek vorige literatuur en die yster tekort anemie teorie, en dui sodoende op ander faktore wat kan bydra tot die voorkoms van cribra orbitalia. Tot die skrywer se kennis, is hierdie die eerste in diepte studie wat ‘n kombinasie van drie metodes gebruik om die siektes van ‘n skeletversameling, verteenwoordegend van Wes-Kaap inwoners, te evalueer en gee sodoende ‘n unieke interpretasie van die gesondheids status van hierdie populasie.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/100117
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