Famine and bone metabolism

Abstract

Throughout history, populations have been exposed to periods of severe food shortage, famine, and starvation. Famine continues to be a major world health issue today with an estimated 794.6 million people (10.9% of the world's population) undernourished in the 2012-2014 period. Historical episodes of famine have sometimes allowed the effects on subsequent health to be studied in detail. For instance, during WWII, the studies of starved children in the Warsaw Ghetto documented bone softening, osteoporosis, and osteomalacia. Histologically the bone marrow was replaced with connective tissue and few myelocytes or chondrocytes were visible. Infants born to women who experienced famine during pregnancy may have increased risk for certain health conditions and there is evidence that musculoskeletal conditions may originate in the intrauterine period. Fetal programming is likely to increase the risk of osteoporosis when the environment during pregnancy is lacking in essential minerals and vitamins. The interplay between the three most important components of bone metabolic health, calcium, vitamin D, and vitamin K, often occur together in communities affected by hunger. Lack of adequate nutrition and vitamin D may lead to Rickets in children. Vitamin K deficiency can lead to intrauterine epiphyseal ossification and adolescent osteoporosis. Folic acid deficiency during pregnancy is also a key factor in neural tube anomaly development. Lathyrism due to famine-related dietary restriction to predominantly one food type, the lathyrus legume species, can lead to osteolathyrism. Symptoms include bone tissue hemorrhage, collagen disease causing bone softening, osteoporosis, and frequent fractures. Famine osteopathy is a conglomerate of metabolic aberrations resulting from nutritional deprivation. Developed countries that welcome immigrants and refugees from famine hit regions should make provision for screening and early detection of metabolic deficiencies such as osteoporosis.