Socio-economic Determinants of Bone Health from Past to Present


Increasing epidemiology evidence amounts for social determinants of bone health underlying musculo-skeletal conditions such as osteoporosis. Amongst different facets influencing skeletal health, socio-economic status (SES) has been identified as a critical factor determining one’s access to resources, health care, education, nutrition, and physical activity. Recent conceptual and epigenetic studies assessing SES links with DNA methylation offer further support for the adverse effects of social disadvantage in early life on bone quantity and quality in adulthood. However, this evidence for socially patterned risks in bone fragility is not restricted to the contemporary society. Data exist for ancient human skeletal samples deriving from SES stratified cemeteries that also reflect bone changes consistent with lifestyles specific to social standing. Similarly to modern data, the conclusion drawn from the ancient times has been for a negative effect of low SES on bone growth and maintenance. Some contradictory results, mirroring previously reported inconsistencies in epidemiological studies, have also been reported showing that high SES can equally result in poor bone health. It becomes clear that ancient perspectives can offer a further line of support into these ongoing epidemiological and epigenetic research efforts. Taken together, a holistic approach to clinical understanding and practice of bone health is recommended, building upon ancient and modern findings to target living groups who are most at risk of developing low bone mass and compromised bone micro-architecture.

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Fig. 1
Fig. 2



Ancient DNA


Bone mineral density


Computed tomography


Diffuse idiopathic skeletal hyperostosis


Dual-energy X-ray absorptiometry


DNA methylation


Developmental Origins of Health and Disease


Genome-wide association study


Linear enamel hypoplasia


Minimum effective strain




Parathyroid hormone


Receptor activator of nuclear factor kappa-Β ligand


Social Determinants of Health


Socio-economic status


Skeletal frailty index


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The authors would like to thank Dr. Patrick Mahoney for facilitating access to samples at the Human Osteology Laboratory at the University of Kent (UK)—image in Fig. 1 represents a sample processed by JJM during her PhD studentship there. We also thank Prof Matthew Allen and Prof Jose Riancho for inviting us to write this review, and two anonymous reviewers whose comments greatly improved our article. The completion of this article was possible thanks to OSP 2019 funds from the Australian National University (to JJM) and the Australian Government Research Training Program (RTP) Scholarship (to KMC).

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Correspondence to Justyna J. Miszkiewicz.

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This article does not feature data from living humans, human autopsies, or animals. We include an image of medieval human femur bone histology sample from an anthropological collection curated at the University of Kent, Canterbury, UK. The collection pre-dates the Human Tissue Act and was studied following the 2008 British Association for Biological Anthropology and Osteoarchaeology (BABAO) Code of Ethics, 2010 BABAO Code of Practice, 2012 American Anthropological Association Code of Ethics, and 2003 Code of Ethics of the American Association of Physical Anthropologists.

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The authors declare that they have no conflict of interest.

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Miszkiewicz, J.J., Cooke, K.M. Socio-economic Determinants of Bone Health from Past to Present. Clinic Rev Bone Miner Metab 17, 109–122 (2019).

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  • Socio-economic status
  • Osteoporosis
  • Inequality
  • Inequity
  • DNA methylation
  • Bone loss
  • Histomorphometry
  • Lifestyle
  • Epigenetics
  • Social epidemiology
  • Bioarchaeology
  • Biological anthropology