Steven Boonen

Hip Fracture and Osteoporosis in a XIIth Dynasty Female Skeleton from Lisht, Upper Egypt

Osteoporosis and complications arising from loss of bone mass have been present in human populations for thousands of years. However, reports of this disease in antiquity remain uncommon. The purpose of this report is to describe an important case of osteoporosis in ancient Egypt because of its intrinsic interest and to provide perspectives on factors contributing to this condition today. The case providing the focus for this report is from Lisht, Upper Egypt and is dated to the XIIth Dynasty (1990–1786 B.C.). Methods used to characterize the pathology include gross anatomical study, radiology, and radiographic measurements. Observations, measurements, and indices all indicate osteoporosis complicated by fracture of the femoral neck and compression fractures of some vertebrae. The Lisht case adds to a small corpus of reports on osteoporosis and complicating factors of this disease in antiquity. Long‐term survival of an extracapsular fracture of the femoral neck in this case is remarkable and may reflect supportive social conditions.

Extraskeletal Risk and Protective Factors for Fractures

Although there are general risk factors for all types of fragility fractures, the risk may differ according to the type of fracture and the period of life when these fractures occur.

Pharmacologic and Non-pharmacologic Strategies to Prevent Hip Fracture in Old Age

Strategies for the prevention of hip fracture should focus on the frequency of falling as well as on the prevalence of compromised femoral integrity as a consequence of bone loss. n n nGiven the high prevalence of falls among the elderly, a performance-oriented functional assessment should be targeted at all patients over 75 years of age. As the risk of falling increases with the number of risk factors, risk may be reduced by modifying even a few contributing factors. n n nIntervention studies have indicated the need to provide adequate supply of both calcium (1500mg daily) and vitamin D (400–800 IU daily) in old age, particularly in housebound elderly and nursing home residents. n n nBisphosphonate treatment reduces the risk of hip fracture among elderly women with confirmed osteoporosis but is not more effective than calcium and vitamin D alone in women identified primarily on the basis of risk factors other than low BMD.

Androgens and Skeletal Homeostasis

Males deprived of androgen action, due to a lack of functional androgen receptors, have a female and not male phenotype (1,2), indicating that the development of the male phenotype depends on androgen action. The skeletal male phenotype is characterized by stronger bones than in females, primarily because male bones have greater size and not because they contain more mineral for similar size (3,4). It would seem logical, therefore, to assume that androgen action is particularly important for gender differences in bone size. Theoretically, androgen action may affect male skeletal homeostasis in utero, during the neonatal period, as well as before and after puberty. Females, on the other hand, do not secrete sex steroids before early puberty. Therefore, it is unlikely that sex steroids affect skeletal homeostasis before early puberty in the female.