Differential survival among individuals with active and healed periosteal new bone formation

Periosteal new bone formation is frequently used in paleopathological and paleoepidemiological studies to diagnose particular diseases or to assess non-specific stress in past populations. Many researchers distinguish between active (woven or unremodeled) and healed (sclerotic or remodeled) periosteal lesions during data collection, but few published studies maintain a distinction between these two activity categories in analysis or interpretation. Though it has been suggested that healed periosteal lesions might indicate relatively good health and enhanced survivorship, no study has explicitly examined this possible relationship in a large skeletal sample that includes both children and adults. This study examines the relationship between periosteal lesion activity (active vs. healed) and survival using a sample of 538 individuals from several medieval London cemeteries, which in combination span the period 1120-1538. The results of Kaplan-Meier survival analysis indicate that healed periosteal lesions are associated with survival advantages compared to both those with active lesions and those without any lesions at all. These results suggest that active periosteal lesions might most closely reflect high frailty and bioarchaeological studies should focus on the distinction between the presence or absence of healing rather than merely on the presence of periosteal lesions irrespective of their activity.