Acknowledgements:

Supported by the U.S. National Science Foundation (BCS-0527658, SES-0138129, BCS-0117958). Special thanks to Kimberly Williams for her assistance in the development of thisresearch, and Ohio State University for continued institutional and facilities support.

To CIAS – Research Centre for Anthropology and Health (FCT-PEst-OE/SADG/UI0283/2019[CM and VM]), University of Coimbra and to FCT (IF/00186/2014 [VM]) – PortugueseFoundation for Science and Technology.

DiscussionThe PR sex differential, with men being significantly more

affected than women, has been extensively described in

previous studies. This is likely a results from the interplay of

multiple biocultural factors.

PR frequency did not significantly increased with age at

death. This finding is not consistent with previous studies that

suggest an accumulation of lifelong effects of non-fatal

physiological stress(11,12) in PR distribution.

The most profound pattern of variation is documented in

the temporal increase in PR in the Early Medieval rural

communities (the small sample for the Industrial period

precludes further discussion). In one hand, the Early Medieval

period is characterized in many European regions by the best

health and nutritional status, prior to the 19th century(13). On the

other hand, our study shows that the effect of the “urban

penalty” was not strongly felt during this period.

Overall, our project did not show significant differences

between urban and rural settlements when regional and

temporal variation, age structure, sex, and SES are accounted

for in the model. This may be interpreted in the light of the

heterogeneity of urbanization in different regional, temporal,

and demographic compositions across Europe, where different

challenges are faced in relation to health and disease.

Material and MethodsA total of 5336 skeletons, 4033 adults (<20 years and older)

and 1303 subadults, meet the inclusion criteria (see Marques

et al. 2019)14. Sample was composed by 2403 males, 1693

females, and 1240 individuals of undetermined sex.

IntroductionA large body of literature has been produced pertaining to

long bone proliferative periosteal reactions (PR) in humanskeletons from past populations. PR have been used as a proxyfor health status, environmental pathogen load, frailty, and“stress” in pre-contemporary groups(1-5). Studies havedocumented higher PR values in populations undergoing majorsubsistence, demographic, and societal transitions(2,4,6-8) (e.g.foraging to farming, urbanization), while others did not(9,10).

Objectives: Unprecedented large-scale analysis of temporal,geographic, and sociodemographic effects on PR prevalence inEurope over the last two millennia.

Could PR function as an indirect assessment of temporo-

spatial variation in health status in Europe?

Proliferative periosteal reactions:assessment of trends in Europe over the past two millennia

Carina Marques1*, Vitor Matos1, Nicholas J. Meinzer2

1 Research Centre for Anthropology and Health, University of Coimbra, Portugal; 2 University in Tübingen, Germany | *anac@ci.uc.pt

ConclusionReconstructing lifeways and health of past populations

through the skeletal phenotypes is necessarily intricate. The

above results show that one cannot assume that PR and health

status are synonymous terms. The enormous socioeconomic,

demographic, and cultural variability in Europe over the last

two millennia certainly produced a wide variability of causative

mechanisms for PR. The usefulness of PR as a measure of a

health transition depends upon local and regional contexts. As

advocated by several scholars, it is sensible to analyze multiple

skeletal health indicators when evaluating population health(2).Figure 2. Share of individuals with PR per age class and sexes.

PR on lower and upper limb long bones was scored as follows:0. Not affected: no PR observed; longitudinal striations; 1. Intermediate: slight discrete patch(es) of PR involving lessthan ¼ of diaphysis; moderate involvement but less than ½ ofthe diaphysis.2. Severe: extensive PR involving over ½ of the diaphysis, with cortical widening and pronounced deformation.Exclusions: Clavicles, hand and foot bones; PR with associated fracture, osteomyelitis, specific infections (TB, leprosy, treponematosis).

Figure 4. Time trends: regression values (controlling for age, sex, geography, settlement, SES)of individuals with at least one bone affected and with tibial lesions.

Figure 3. Share of individuals with PR by urbanization group and time period.

Variable Category PRpercent (nPR present/Ntotal)

Age at death Adults 23.4% (942/4033)p<0.001

Subadults 18.4% (240/1303)

Sex Males 25.2% (606/2403)p<0.05

Females 20.6% (348/1693)

Undetermined 22.5% (228/1012)

Long limb bones Humeri 2.7% (97/3630)

Ulnae 2.3% (75/3263)

Radii 2.1% (70/3276)

Femora 8.5% (344/4042)

Tibiae 20.7% (835/4040)

Fibulae 12.9% (402/3127)

Settlement type Urban 20.1% (635/3165)p<0.001

Rural 25.2% (547/2171)

Time period(centuries)

Pre-Medieval (≤ 4th) 25.3% (115/454)

Early Medieval (5th-9th) 31.7% (273/861) p=0.02*

High Medieval (10th-12th) 21.4% (174/814)

Late Medieval (13th-15th) 22.3% (125/561)

Early Modern (16th-18th) 16.7% (393/2350)

Industrial (19th-20th) 34.5% (102/296)

Major Europeanregions

Northeast 19.0% (469/2463)

Northwest 30.6% (322/1052)

Central/South 19.7% (284/1440)

Mediterranean 28.1% (107/381) p=0.02*

Socioeconomicstructure

Farmers 26.3% (576/2189)

Workers 19.8% (458/2310)

Military 16.0% (28/175)

Religious 29.7% (33/111)

Hospital 12.2% (40/328)

Other 21.1% (47/223)

TOTAL 22.2% (1182/5336)

ResultsPR was present on 22.2% (1182/5336) of the skeletons

(presence of at least one bone affected per individual). The

main findings are summarized on table 1.

Table 1. Share of individuals with PR by main categories (*p-value when controlled for other variables).

Regression analysis (controlling for sex and time period) did

not show a significant positive trend in PR with increasing age at

death (p=0.249) (Fig. 2).

Rural settlements of the Early Medieval period show the

highest PR scores (Fig. 3). In the urban counterparts, PR peaks

in the High Medieval and Industrial periods.

Regression model (controlling for geography, age at death,

sex, settlement, and SES) is significant for the Early Medieval

(p=0.05), High Medieval (p=0.01), and Industrial periods

(p=0.05) when the early modern period is the reference

category (Fig. 4). Similar trend is seen in the four regions.

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Figure 1. Examples of PR on long bones (photos: VM).