A (not so) brief historical overview of porous skeletal lesions (PSLs)

Abstract

The etiology and interpretation of porous skeletal lesions (PSLs)—cribra cranii, orbitalia, humeralis, and femoralis—remain under debate. This article contextualizes the historical development of PSL research, from early racial classifications of cranial cribra in the 19th century to their mid-20th-century recognition as pathological conditions. From the 1960s onward, cribra were associated with genetic hemolytic anemias in malaria-endemic regions, and later with iron-deficiency anemia linked to diet, parasitism, and maize consumption. Although the IDA model dominated for decades, alternative explanations gradually emphasized other anemia types, inflammatory processes, vascular remodeling, and nonspecific stress. The early 21st century brought recognition of postcranial cribra, diversifying etiological inferences, and more recently, the integration of physiological, environmental, and biosocial perspectives. Furthermore, advances in imaging and elemental analyses have been revealing new interpretative pathways, showing associations between PSLs, respiratory infections, and social inequality. Rather than offering a contemporary state-of-the-art review, this study situates PSLs within a long trajectory of shifting interpretations, demonstrating how evolving scientific and methodological frameworks have shaped their meaning. It argues that PSLs should be interpreted as heterogeneous, context-dependent expressions of homeostatic disruptions and adaptation integrated within the biosocial dimensions of past health.