Anemia, frailty, and mortality in a contemporary skeletal population from Milan, Italy

Iron-deficiency anemia is typically caused by inadequate intake and/or absorption of iron, usually due to poor diet or blood loss resulting from parasitic infection. Worldwide, females often show higher levels of anemia than males due to menstruation and pregnancy. This study investigates whether skeletal evidence for anemia (i.e., porotic hyperostosis, PH) serves as an indicator of frailty, i.e., whether lesions contribute to increased susceptibility to disease and/or increased risk of death. The individuals (N=405) are from a large, documented, 20th century Italian sample from the city of Milan, in northern Italy. Chi-square statistics compared the presence of cranial lesions against known sex, age groups, and cause of death to investigate potential heterogeneity in frailty and the relationship between lesions and risk of death or disease. Results indicate PH lesions were significantly different between males and females; surprisingly, more than twice as common in males (58%) than females (24%) (p<0.0001). Additionally, the presence of lesions was dependent on age for both males (p=0.0002) and females (p=0.0027). Older individuals showed a higher frequency of lesions than younger individuals, suggesting long-term survival with the condition. However, no association was detected between lesion presence and cause of death attributed to either degenerative disorders or neoplasms for either sex (male p=0.2107, female p=0.7883). The high frequency of lesions overall suggests that anemia was a common chronic ailment linked to sanitation, nutrition, and healthcare. Significant socio-political upheaval in Italy during the 20th century likely affected health outcomes for the resident population.