**Osteoporosis in Alaska Natives**

Pratt and Holloway recently published data from the orthopedic
department at ANMC. It showed that incidence of hip fractures in Alaska
Native (AN) women over 64 was higher than the incidence in white US
women in 1979-1989 and had increased further by 1996-1999. The hip
fracture rate among AN men was higher than US white men in 1996-1999.

Pratt WB, Holloway JM Incidence of hip fracture in Alaska Inuit people:

1979-1989 and 1996-1999. Alaska Medicine 2001 43(1):2-5

[PubMed References and Conclusions]{.underline}:

Perry HM 3rd, Bernard M, Horowitz M, Miller DK, Fleming S, Baker MZ,
Flaherty J, Purushothaman R. The effect of aging on bone mineral
metabolism and bone mass in Native American women. J Am Geriatr Soc.
1998 Nov;46(11):1418-22.

CONCLUSIONS: In Native American women, there is a reduction in bone
density and a sustained increase in bone turnover postmenopausally. BMI
and serum 25OHD are significant determinants of BMD. Peak BMD may be
higher, and the postmenopausal rate of bone loss greater, than that in
white women.

Bridges PS. Spondylolysis and its relationship to degenerative joint
disease in the prehistoric southeastern United States. Am J Phys
Anthropol. 1989 Jul;79(3):321-9. Spondylolysis, a fatigue fracture in
the neural arch of lumbar vertebrae, is common in Eskimos and some
athletes. In Archaic Indians from northwestern Alabama, 17% of males and
20% of females with complete lumbar regions showed this defect. It is
found at a fairly early age in adult males in this group, but in females
it does not appear until after age 40 years. Spondylolysis is associated
with higher levels of osteoarthritis around the fifth lumbar vertebra,
where this defect typically occurs. Otherwise, there is little
relationship between its presence and degenerative joint disease,
especially in the weight-bearing joints. The incidence in young males
may be related to activities necessitating a high level of mobility
around the lumbar spine. The late occurrence in females suggests that
osteoporosis may have been a contributing factor.

Walker PL. Porotic hyperostosis in a marine-dependent California Indian
population. Am J Phys Anthropol. 1986 Mar;69(3):345-54. A maize-based
iron- and protein-deficient diet is commonly cited as the most important
cause of porotic hyperostosis among American Indian agriculturalists. An
alternative to this maize dependence hypothesis is suggested by the
analysis of 432 crania from the nonagricultural, fish-dependent
population of the Channel Island area of southern California. Cribra
orbitalia, a form of porotic hyperostosis associated with iron
deficiency anemia, is just as common among these fisherpeople, whose
diet was rich in iron and essential amino acids, as it is among
maize-dependent agriculturalists. Northern Channel Island crania have
much more cribra orbitalia than those from the California mainland. The
highest incidence is on San Miguel, a small geographically isolated
island with a shortage of fresh water and terrestrial resources. The
Indians who lived on Santa Cruz, the largest of the northern Channel
Islands with the greatest diversity of terrestrial plants and animals,
have less than those who lived on Santa Rosa or San Miguel Island. This
geographical distribution appears to be explained by island-mainland and
interisland differences in water contamination, exposure to fish-borne
parasites, and nutritional adequacy of the diet. The prevalence of
porotic hyperostosis in a population with a heavy dietary dependence on
marine resources shows that among prehistoric American Indians, this
condition is not always associated with an iron- and protein-deficient
diet o cultigens. It seems likely that high nutrient losses associated
with diarrheal disease are often more significant in the etiology of
porotic hyperostosis than a low dietary intake of essential nutrients

Ericksen MF. Cortical bone loss with age in three native American
populations Am J Phys Anthropol. 1976 Nov;45(3 PT 1):443-52 Age-related
thinning of cortical bone was investigated in archaeological populations
of Eskimos, Pueblos, and Arikaras. Medial-lateral cortical thickness was
measured on radiographs of humerus and femur, and thickness of the
anterior femoral cortex was measured directly on samples taken for
study. Maximum length of the bones was used to calculate indices of
relative cortical thickness, in order to minimize differences due to
body size and build. Bone loss in the humerus begins before middle age
in all three populations and, except for Eskimo males, the same is true
of the anterior femoral cortex. In general, overall female loss of bone
amounts to two or three times that of the males, and in the case of the
humerus and the anterior cortex of the femur, this difference is evident
by middle age. The weight-bearing femoral medial-lateral cortex shows
less sexual difference but has the greatest number of statistically
significant differences between populations and the greatest contrast
between populations in pattern of loss with age. It appears that of the
cortical regions studied this is the area upon which environmental
factors have the greatest effect, whereas areas more subject to tensile
stress, the humerus and anterior femoral cortex, are less affected by
these factors.

El-Najjar MY, Ryan DJ, Turner CG 2nd, Lozoff B. The etiology and porotic
hyperostosis among the prehistoric and historic Anasazi Indians of
Southwestern United States. Am J Phys Anthropol. 1976 May;44(3):477-87

Porotic hyperostosis was studied in 539 crania from maize-growing
prehistoric and historic groups who occupied two dissimilar ecological
zones of the Plateau country of Arizona and New Mexico\--canyon bottoms
and sage plain. Defined as abnormal localized sieve-like structural
changes involving the hematopoietic areas of the cranium, it was found
in 185 (34.3%) of these skulls. More frequent in children than in
adults, it shows significant frequency differences between both children
and adults of the two ecological zones. The two ecological zones differ
in the availability of iron in the diet; the canyon inhabitants depended
heavily on maize (which interferes with iron absorption) while the sage
plain people consumed more iron-rich animal products. We hypothesize
that an increased dependence on maize produced more iron deficiency
anemia and resulted in more porotic hyperostosis. Maize is known to have
permitted a food surplus which in turn allowed for increased
Southwestern population growth in marginal areas like the canyon
bottoms. Heavy dependency on a single food type with consequent
hematologic problems may have been an important reason for the
subsequent abandonment of the Anasazi region.

El-Najjar MY, Lozoff B, Ryan DJ. The paleoepidemiology of porotic
hyperostosis in the American Southwest: Radiological and ecological
considerations. J Roentgenol Radium Ther Nucl Med. 1975
Dec;125(4):918-24.

Porotic hyperostosis was observed in 34 percent of 539 crania excavated
from sites in Arizona and New Mexico. Common causes of this cranial
pathology in the Old World (thalassemia, sickel cell anemia, and
malargia) do not explain its occurrence in the American Southwest, as
malaria and hemoglobinopathies are not known to have existed in the New
World prior to European contact. Iron deficiency anemia which may also
be assoicated with porotic hyperostosis occurs on a mass level only with
hookworm infestation or nutritionally-related iron deficiency. Since
hookworm infestation is rare in the American southwest and has not been
reported in prehistoric southwestern American Indians, the hypothesis of
nutritional anemia was examined. In canyon bottom sites where the diet
was heavily dependent on maize, which is low in iron and also contains
an inhibitor of iron absorption, significantly more crania had porotic
hyperostosis than in sage plain sites, where the diet included ample
animal protein rich in easily absorbable iron (p less than .001).
Furthermore, canyon bottom children, who were more susceptible to iron
deficiency anemia, had a higher incidence of porotic hyperostosis
lesions than adults (p less than .0001).

Abstract Online

Pratt WB, Holloway JM Incidence of hip fracture in Alaska Inuit people:

1979-1989 and 1996-1999. Alaska Medicine 2001 43(1):2-5

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11345855&dopt=Abstract>

Bridges PS. Spondylolysis and its relationship to degenerative joint
disease in the prehistoric southeastern United States. Am J Phys
Anthropol 1989 Jul;79(3):321-9

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2669502&dopt=Abstract>

Perry HM 3rd, Bernard M, Horowitz M, Miller DK, Fleming S, Baker MZ,
Flaherty J, Purushothaman R. The effect of aging on bone mineral
metabolism and bone mass in Native American women. J Am Geriatr Soc.
1998 Nov;46(11):1418-22.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9809765&dopt=Abstract>

Walker PL. Porotic hyperostosis in a marine-dependent California Indian
population. Am J Phys Anthropol. 1986 Mar;69(3):345-54.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3518481&dopt=Abstract>

Ericksen MF. Cortical bone loss with age in three native American
populations Am J Phys Anthropol. 1976 Nov;45(3 PT 1):443-52

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=998766&dopt=Abstract>

El-Najjar MY, Ryan DJ, Turner CG 2nd, Lozoff B. The etiology and porotic
hyperostosis among the prehistoric and historic Anasazi Indians of
Southwestern United States. Am J Phys Anthropol. 1976 May;44(3):477-87

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=937525&dopt=Abstract>

El-Najjar MY, Lozoff B, Ryan DJ. The paleoepidemiology of porotic
hyperostosis in the American Southwest: Radiological and ecological
considerations. J Roentgenol Radium Ther Nucl Med. 1975
Dec;125(4):918-24.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1108684&dopt=Abstract>

Bell RA, Quandt SA, Spangler JG, Case LD. Dietary calcium intake and
supplement use among older African American, white, and Native American
women in a rural southeastern community. J Am Diet Assoc 2002
Jun;102(6):844-7

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12067054&dopt=Abstract>

Evers SE, Orchard JW, Haddad RG. Bone density in postmenopausal North
American Indian and Caucasian females. Hum Biol. 1985 Dec;57(4):719-26.
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=4086025&dopt=Abstract>

Perzigian AJ. Osteoporotic bone loss in two prehistoric Indian
populations. Am J Phys Anthropol. 1973 Jul;39(1):87-95.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=4351578&dopt=Abstract>

Perzigian AJ. The antiquity of age-associated bone demineralization in
man. J Am Geriatr Soc. 1973 Mar;21(3):100-5.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=4349803&dopt=Abstract>