Evidence of hypertrophic osteoarthropathy in individuals from the Coimbra Skeletal Identified Collection (Portugal)

Hypertrophic osteoarthropathy (HOA) is characterized by symmetrical periosteal new bone deposition on the long and short tubular bones. Besides its unknown etiology, it has been associated with pulmonary, cardiovascular and gastrointestinal disorders. The aims of this research were to assess the presence of HOA and to analyze its distribution by sex, age at death, bones affected, type of new bone formed, and cause of death. A sample of 329 individuals (non-adults and adults, of both sexes) was selected from the Coimbra Skeletal Identified Collection. The sample comprised 125 individuals diagnosed with tuberculosis, 64 with pulmonary non-tuberculosis, and 140 with an extrapulmonary and non-tuberculous cause of death. Lesions compatible with HOA were found in all three groups, being statistically significantly in the individuals who died from pulmonary diseases (χ²=5.29, df=1, p=0.02). The risk of developing HOA was 3.41 (χ²=7.77, df=1, p=0.005) higher in the individuals with tuberculosis when compared with the other groups. This work, based on individuals who died before the introduction of antibiotics for treatment, agrees with clinical studies that have established a possible correlation between pulmonary conditions and HOA. These data may help in differentially diagnosing the many instances of periosteal new bone formation found in archaeologically derived skeletal samples.