An Investigation of Skeletal Indicators of Vitamin D Deficiency in Adults: Effective Markers for Interpreting Past Living Conditions and Pollution Levels in 18th and 19th Century Birmingham, England Megan Brickley, 1 * Simon Mays, 2 and Rachel Ives 1 1 Institute of Archaeology and Antiquity, School of Historical Studies, The University of Birmingham, Edgbaston, Birmingham B15 2TT, UK 2 English Heritage Centre for Archaeology, Fort Cumberland, Eastney, Portsmouth PO4 9LD, UK KEY WORDS osteomalacia; vitamin D deficiency; paleopathology; metabolic disease ABSTRACT Vitamin D deficiency in adults is referred to as osteomalacia, and this condition has multiple causes related to factors such as environment, living conditions and cultural practices. Therefore, understanding the types and range of expression of osteomalacia in archaeo- logical bone, using a number of investigative techniques, will have significant implications for interpretations made about past communities. This study aimed to understand the expression of vitamin D deficiency in the skeletons of adults through detailed analysis of human bone from the late 18 th and 19 th century churchyard of St. Martin’s, Birmingham, England, at a gross, radiologi- cal and histological level. The collection from St. Martin’s is unusual for the period as this central burial ground in Birmingham was used by a wide cross section of society rather than a narrow socio-economic group as at other sites of this date. Macroscopic and radiological analysis of 291 adults identified seven individuals with osteomala- cia, and histological analysis using back-scattered scan- ning electron microscopy confirmed the findings. Detailed description of the range of pathological alterations observed in the archaeological skeletons are presented, and possible interpretations of the patterns seen consid- ered. The results of this investigation will enable clear di- agnosis and interpretation of this vitamin D deficiency disease, an important socio-economic indicator, to take place in the future. Am J Phys Anthropol 132:67–79, 2007. V V C 2006 Wiley-Liss, Inc. Vitamin D deficiency has multiple causes related to fac- tors such as environment and living conditions (Ortner and Mays, 1998; Al-Jurayyan, 2002; Reginato and Coquia, 2003). Therefore, understanding the type and range of expressions of this deficiency in archaeological bone will have significant implications for interpretations made about past communities. However, to date few con- vincing cases of osteomalacia have been reported from archaeological skeletal material from around the world, and it is likely that many cases are being missed. The current research demonstrated the extent to which bones may be significantly weakened because of the presence of large amounts of unmineralized osteoid in osteomalacia. Skeletons of individuals with the condition that are bur- ied in the ground are easily fragmented (as illustrated in Fig. 1), and characteristic changes may not be noticed unless the person undertaking the recording is aware of the features of the condition (Brickley et al., 2005). An extensive review of the bone changes linked to osteo- malacia has established criteria that will enhance the identification of vitamin D deficiency in archaeological human bone (Brickley et al., 2005). The current paper presents the results of an investigation into the identifica- tion of osteomalacia from human burials excavated from a significant post-medieval burial ground in Birmingham, England, dating to the 18th and 19th centuries. Documentary evidence for post-medieval Britain (1550– 1850 AD) clearly demonstrates that vitamin D deficiency persistently affected juveniles within the population at this time, causing the British Medical Association to com- mission surveys to determine the geographical extent of the spread of rickets in 1889 (Owen, 1889). It is unlikely that the conditions necessary to cause rickets in children did not also affect the adults, although growth in children will lead to more pronounced expressions of the condition. However, it is surprising that to date only two post-medieval sites in England have yielded archaeological evidence for osteomalacia; Broadgate (White, 1985) where two individ- uals were identified (although the specific pathological changes are not discussed) and 12 individuals from Christ Church Spitalfields reportedly had ‘‘acutely angulated sacra, probably the result of adolescent rickets (osteoma- lacia)’’ (Molleson and Cox, 1993). The present study is the first to examine the consistent manifestations of vitamin D deficiency (osteomalacia) in archaeological human remains from the post-medieval period in Britain. Vitamin D is a pro-hormone that is essential for adequate mineralization of newly formed bone (osteoid) Grant sponsor: Natural Environment Research Council; Grant numbers: NER/A/S/2002/00486. *Correspondence to: Dr. M. Brickley, Institute of Archaeology and Antiquity, School of Historical Studies, The University of Birming- ham, Edgbaston, Birmingham B15 2TT, UK. E-mail: m.b.brickley@bham.ac.uk Received 1 March 2006; accepted 21 June 2006. DOI 10.1002/ajpa.20491 Published online 31 October 2006 in Wiley InterScience (www.interscience.wiley.com). V V C 2006 WILEY-LISS, INC. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 132:67–79 (2007)