Abstract
This paper presents evidence for hypomineralisation disorders (rickets and osteomalacia) in non-adults at Man Bac, a Neolithic site from northern Vietnam dated to 4000-3500BP, contributing to the well described disease burden at the site that includes scurvy, treponemal disease, thalassaemia, and malaria. Forty-four non-adults (< 20 years of age-at-death) were assessed for macroscopic and radiographic evidence for hypomineralisation disorders.
Differential diagnosis was completed using traditional methods and three-level standardised criteria to combat the challenges of overlapping pathological features between hypomineralisation disorder and the other diseases already diagnosed at the site. In addition, a diagnostic certainty approach was applied to investigate the impact of lesion ambiguity on our findings. Kaplan-Meier and Fishers exact tests were applied to assess age-at-death related epidemiological patterns of hypomineralisation disorder, and co-morbid relationships with
scurvy, thalassaemia, and treponemal disease. Almost 50% of the non-adult assemblage presented with evidence for hypomineralisation disorder which was associated with decreased survivorship in childhood. Potential epidemiological relationships between scurvy and hypomineralisation disorders, and thalassaemia and hypomineralisation disorders are described. The former relationship may be due to the likelihood of the introduction of rice resulting in multi-micronutrient deficiency, including vitamin C and calcium deficiency, and cultural attitudes to sunlight. The latter relationship may relate to the pathophysiology of thalassaemia which can result in secondary osteomalacia possibly contributing to the development of hypomineralisation disorder in the thalassaemic non-adults. The findings are significant as they present possible approaches for diagnosis of disease embedded within complex disease burdens where individuals are likely suffering from co-morbidities.
Differential diagnosis was completed using traditional methods and three-level standardised criteria to combat the challenges of overlapping pathological features between hypomineralisation disorder and the other diseases already diagnosed at the site. In addition, a diagnostic certainty approach was applied to investigate the impact of lesion ambiguity on our findings. Kaplan-Meier and Fishers exact tests were applied to assess age-at-death related epidemiological patterns of hypomineralisation disorder, and co-morbid relationships with
scurvy, thalassaemia, and treponemal disease. Almost 50% of the non-adult assemblage presented with evidence for hypomineralisation disorder which was associated with decreased survivorship in childhood. Potential epidemiological relationships between scurvy and hypomineralisation disorders, and thalassaemia and hypomineralisation disorders are described. The former relationship may be due to the likelihood of the introduction of rice resulting in multi-micronutrient deficiency, including vitamin C and calcium deficiency, and cultural attitudes to sunlight. The latter relationship may relate to the pathophysiology of thalassaemia which can result in secondary osteomalacia possibly contributing to the development of hypomineralisation disorder in the thalassaemic non-adults. The findings are significant as they present possible approaches for diagnosis of disease embedded within complex disease burdens where individuals are likely suffering from co-morbidities.
| Original language | English |
|---|---|
| Journal | International journal of osteoarchaeology |
| Publication status | Accepted/In press - 7 Feb 2024 |
Bibliographical note
AcknowledgementsPermissions for access and publication of the skeletal assemblage were granted by the Institute for Archaeology, Hanoi, Vietnam in 2018. We would like to thank Dr Ngo Anh Son, Dr Bui Van Khanh, and Dr Nellissa Ling for their assistance with the radiographs. This work was supported by Australian Research Council (DP110101097, FT120100299); National Geographic Early Career Grant (EC-54332R-18); Royal Society of New Zealand Skinner Fund Grant; and a University of Otago Doctoral Scholarship.
