DEPARTMENT OF ANATOMICAL SCIENCES
AN321 - FORENSIC OSTEOLOGY
W. B. Wood
The University of Queensland
Most forensic anthropologists are not experts in the recognition of bony pathology but some have made it their specialty particularly in the area of paleopathology (Brothwell & Sandison 1967; Ortner & Putschar 1981; Steinbock 1976)
When pathology or bony anomalies are observed to be present then they must be fully described, photographed, radiographed and (in the case of pathology) examined microscopically so as to identify their nature and extent. Many of the chronic infectious diseases that leave their mark on bone have overlapping morphological features that make differential diagnosis almost impossible.
Needless to say, the advice of a consultant pathologist and radiologist should always be sought before any definitive conclusion is made.
Problems may arise where postmortem artifacts of bones may mimic disease processes (eg termite or root activity) and viceversa, or where anomalies of bone may be confused with antemortem or perimortem trauma e.g. from a gunshot wound (Taylor 1974, Duflou & Oettle 1990).
The presence of bony pathology or specific anomalies may assist in individual identification if antemortem records are available for comparison. It is only rarely however that the presence of bone pathology assists in the determination of the probable cause of death.
A good modern reference text for an introduction to bony disease and abnormalities is the book Outline of Orthopaedics by Crawford Adams (1981).
Skeletal pathology may be subdivided into disorders of bones and disorders of joints.
AETIOLOGY OF PATHOLOGICAL PROCESSES
Genetic: inherited genetic defects
Acquired: caused by environmental influences
TERMINOLOGY OF BONE & CARTILAGE PATHOLOGY & ABNORMALITIES
Conditions that are handed on from parent to child due to a genetic
abnormalities are called INHERITED conditions.
Conditions that are the result of abnormal growth and development of
cartilage or bone are called DEVELOPMENTAL abnormalities.
Conditions that are present at birth are said to be CONGENITAL regardless of
whether they are due to inherited genetic defects or developmental abnormalities
caused by abnormal intrauterine environmental factors.
Some bone pathology is LOCALISED while other affections are part of a
GENERALISED disease process affecting the whole body.
Diseases of bone result in abnormal bone formation, destruction, pathological
fractures, dislocations or deformity.
Inflammatory - acute
Neoplastic - benign
Metabolic (Nutritional & Endocrine)
These conditions are usually generalized throughout the body and may or
may not be obvious at birth:
Cartilage Dysplasias: abnormal cartilage development
Achondroplasia (congenital dwarfism - marked shortening of the limbs)
Osteochondromatosis (multiple exostoses)
Bone Dysplasias: abnormal bone development
Osteogenesis imperfecta (fragilitas ossium)
Fibrous dysplasia - single or multiple cysts in bones
These conditions may be inherited or acquired (secondary). They are usually localized and
obvious at birth:
Congenital dislocated hip (CDH)
Congenital genu varus/valgus (bow-leg; knock-kneed)
Reduction deformities - part or whole of a limb is absent
Fusion deformities - syndactyly; lobster claw hand, sacralization of L5
Extra digits - polydactyly
Club foot (Talipes equino varus)
Pes planus (flat-foot)
Spina bifida (absent vertebral arch)
Congenital scoliosis - usually due to a hemi-vertebra
BONE & JOINT INFLAMMATION (OSTEITIS/ARTHRITIS)
Usually due to pyogenic (pus forming) organisms
Acute Inflammation (cont.)
Signs: redness, heat, pain, swelling, loss of function
pus formation, bone and cartilage destruction
The bony lesions of acute osteomyelitis typically demonstrate an
involucrum of coarsely woven bone overlying or surrounding the surface of
the original bone and perforated by one or more sinuses (fistulae) for the
escape of pus from the medullary cavity. Embedded in the involucrum may be one or more pieces of dead bone (sequestra).
Acute septic arthritis may lead to total joint disruption with fibrous or bony
In acute periostitis, woven bone is laid down on the surface of the bony
cortex but there is no involvement of the medullary cavity and no formation
Pyogenic organisms (chronic osteomyelitis)
recurrent or continuing symptoms and signs of inflammation persistent pus draining from sinuses
destruction of bone and cartilage (osteolysis/chondrolysis) or
abnormal bone formation and thickening (osteogenesis)
a chronic infection of bone which results in bone and joint
usually there is little or no evidence of bony reaction
attacks especially the vertebral column resulting in vertebral collapse and the development of kyphosis (sharp posterior angulation of the
no associated evidence of sequestra formation, involucrum, or fusion
Syphilis & yaws
these are chronic infections of bone caused by related organisms.
usually the disease focuses on the bones of the cranial vault, the facial skeleton or the tibia.
there may be localized (fusiform swelling) of the shaft of a bone or
generalized subperiosteal new bone formation due to periostitis,
localised areas of bony destruction or rarefaction with dense
thickening of the overlying cortex, diffuse sclerotic thickening of the
whole bone. Radiologically the appearances vary from severe
osteoporosis to dense sclerosis.
BONE & CARTILAGE NEOPLASMS (TUMOURS)
True bony neoplasms result from the uncontrolled growth of bone, bone marrow
and cartilage cells.
Benign neoplasms are self limiting and tend to remain localised.
Malignant neoplasms tend to spread throughout the body via tissue planes, body
cavities and via blood and lymphatic vessels.
osteoma - occur in about 1% of people
especially common on the ectocranial surface
as a discrete mound of compact bone
osteochondroma - arise at epiphysial lines, project at right angles and
resemble ossified tendons
NOTE: auditory exostoses (osteomata) may occur in the external
These may be either primary or secondary (metastatic)
Metastatic neoplasms with primary centers located in other organs or tissues
of the body are much more common in bone than primary bony neoplasms.
Secondary: these are usually of epithelial origin
Most malignant neoplasms cause swelling of the affected bone associated with
bone resorption (destruction or lysis). Radiographically they demonstrate localized
radiolucency of bone tissue.
Others may stimulate bone formation so that radioopaque areas may be present in
the bone radiograph.
DEGENERATIVE BONE & CARTILAGE PATHOLOGY
most commonly associated with aged individuals and better termed
degenerative joint disease
characterized by periarticular bony lipping (osteophytes) and spur formation
often associated with eburnation (a polished ivory-like appearance of
synovial joint articular surfaces) due to the exposure of subchondral bone.
may be localized (post traumatic) or more generalized and affecting
especially the vertebral column and large limb joints.
severe degrees may lead eventually to bony ankylosis of joints
this is a chronic non-bacterial inflammation of joints that nearly always
affects several joints at the same time (polyarthritis).
the cause is unknown but may be associated with autoimmune disease.
the condition often starts in the young adult and occurs more frequently in
the condition causes thickening of the articular capsule, softening and erosion of the articular cartilage.
eventually erosion and destruction of the subchondral bone and secondary
osteoarthritis may develop.
a chronic disease of the vertebral column in which the ligaments of the
vertebral column become ossified and the intervertebral joints become
CIRCULATORY BONE DISEASE
This is usually due to a disturbance of the blood supply (reduced or absent) to
bone or cartilage.
This may lead to avascular necrosis of bone or cartilage.
Keinbock's disease of the wrist (necrosis of the lunate bone)
Perthe's disease of the hip (necrosis of the proximal epiphysis of the hip)
Anaemias may also affect bone leading to a widening of the haematopoietic
marrow spaces in bones (or the diploe in the cranium vault).
Porotic hyperostosis (spongy hyperostosis) is a condition affecting the cranial
vault which is probably anaemia related. There is a thinning and often
complete destruction of the outer table of the cranial vault (especially in the
parietal bones) with exposure of the spongy (sieve-like) diploe. Similar affects
may appear in the orbital roof (cribra orbitalis) or endocranial surface (cribra
METABOLIC BONE DISEASE
NUTRITIVE &/OR ENDOCRINE
In these conditions there is a generalized reduction in bone mass as a result of
inadequate osteoid production or mineralization, or of excessive demineralisation of
a generalized loss of calcium from the bones especially in
multifactorial in aetiology, with hormonal, dietary and reduced activity all
playing a part.
Due to deficient calcium absorption and/or metabolism
Rickets (lack of vitamin D) causes softening and bending of bones
due to excessive production of osteoid and a failure of osteoid tissue to ossify (calcify).
Skeletal effects are most obvious in the long bones, which become
bent and distorted.
Adult osteomalacia - causes generalized osteoporosis & crush
fractures of vertebrae, or stress fractures of ribs, sternum & pelvis.
Due to insufficient intake of Vitamin C which is essential for the production
of collagen and therefore of osteoid.
Usually presents as cortical thinning and pathological fractures especially in
infants and young children.
Hyperparathyroidism (Osteitis Fibrosa Cystica)
Due to excess production of parathyroid hormone.
There is loss of mineralized bone due to overactive osteoclastic resorption
There is generalized osteoporosis and the development of cystic lesions
throughout the bones.
Due to overproduction of somatotrophic hormones (e.g. growth hormone) in
the growing child.
All the bones become excessively large.
Similar cause as for gigantism but only when it develops in adult
individuals after the growth epiphyses have closed.
Results in an individual with excessively large mandible, hands and feet.
a very common bone disease (4% over 50yr olds in the UK)
characterized by disordered bone architecture associated with:
bone thickening, deformity,
a metabolic disease due to abnormal urate metabolism. Results in the
deposition of urate crystals in the periarticular tissues associated with acute
Metal poisoning eg lead, mercury, bismuth, and phosphorus, often cause
metaphysial (and occasionally diaphysial) bands of increased density.
Fluoride intoxication may cause diffuse sclerosis with undulating periosteal
Brothwell D & AT Sandison 1967 Diseases in Antiquity CC Thomas Springfield Illinois
Crawford Adams J 1981 Outline of Orthopaedics 9th Edition, Churchill Livingstone
Crawford Adams J 1978 Outline of Fractures 7th Edition, Churchill Livingstone
Duflou J & THG Oettle 1990 "Bony Foramina in Forensic Medicine". Paper (No A553)
presented at the 12th Meeting of the International Association of Forensic Science Adelaide 1990
Ortner DJ & WGJ Putschar 1981 Identification of Pathological Conditions in Human Skeletal Remains Smithsonian Contributions to Anthropology No 28 Smithsonian Institution Press Washington DC
Steinbock RT 1976 Paleopathological Diagnosis and Interpretation. CC Thomas
Taylor HL 1974 "The Sternal Foramen: The Possible Forensic Misinterpretation of an Anatomic Abnormality" JFS 19(4):730-734