AboutBone Turns Three

Three years ago today, the first post, Why Bone, appeared at www.aboutbone.com

The inaugural post concluded with: “I will compare bone to sewing thread, Tootsie Pops, licorice sticks, and jazz. … Learning should always be fun, which is easy when telling this story. … The blog is an opportunity to extol the wonders of bone as it supports life and captures history. Let me know if you have questions or if there is some aspect of this wonderful substance that you would like to learn more about.”

Now 79 posts later, AboutBone remains true to its original vision. Early on, I was concerned about eventually running out of topics. No way! Between the leads I find and ones that readers send me, I have enough topics that I could hammer your in box with a new announcement weekly. But as enduring and endearing as bone is, we DO have other things to attend to. So I plan to continue to post a new article every 2-3 weeks.

Looking back: Here are five of the most popular posts, whose topics span 3.2 million years from anthropology and the history of anatomy to a thriving 19th century bone business, a 20th century orthopedic mistake with serendipitous results, and a space-age interplanetary application.

Looking forward: After an eight-year incubation, BONES, Inside and Out, will launch October 20. An audiobook version and translations into Korean and Russian will soon follow along with several podcast interviews and virtual book signings. Advance praise for BONES includes:

  • I loved this book. It has everything I want in science writing: plain explanations, conversational tone, a little bit of the author’s journey, and a fair amount of humor. Goodreads
  • An expansive and lively treatment of a material most of us take for granted. Kirkus, starred review

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Three Rare and Illuminating Bone Diseases

Naturally we tend to take things for granted unless something is amiss, and so it is with our bones. Sure, people take note when they have arthritis or osteoporosis, and a fracture commands the bone owner’s complete attention. For the moment, however, appreciate how close to normal your bones are. A good way to do so is to understand that normality is not universal and that there are some amazing and strange ways that bone can go bad—so strange and rare that most orthopedists, myself included, have never encountered a patient so afflicted. However, we do read about these diseases in journal articles, and the topics may appear on certification exams. Here is a brief overview of three rare conditions that will definitely heighten your appreciation of normal bones.

The first is the genetic deficiency of an enzyme, alkaline phosphatase, which bone-building cells need to function. Bone growth and turnover are normally a balance between bone production and degradation; but in this condition, hypophosphatasia, bone is slowly resorbed and not replaced. In the severe early-childhood form of this disease, the ribs melt away, and the patient requires mechanical assistance for breathing. Early death ensues, at least until recently. Now the disease can be thwarted by periodic, lifelong injections of a synthetic form of the missing enzyme.

Although not fatal, the second condition, vanishing bone disease, is even more vexatious because nobody knows its cause. It can occur at any age but shows up most commonly in young adults where large segments of bone in a given region, typically face or upper arm, just gradually disappear. When it attacks the ribs, it can be fatal, otherwise it is just disabling, since the affected part of the skeleton lacks stability. For instance, contracting the muscles in a transformed arm just telescope the limb rather than bend and straighten the joints. Sometimes the process stops spontaneously, but it is not known to reverse. Radiation may provide some benefit but risks later malignant transformation. At times grafted bone can span the defect and improve stability and function.

Courtesy Jon-co, wikimedia

In the third condition, an overabundance of bone rather than a dearth causes problems. It’s called fibrodysplasia ossificans progressive (FOP). A chemical messenger, bone morphogenetic protein, normally stimulates bone cells to make bone, which is a process integral to bone growth and fracture healing. In FOP, bone morphogenetic protein does not get switched off, and it stimulates bone formation in extra-skeletal locations, starting in the neck and shoulder muscles and gradually working its way down the spine and into the limbs. Any muscle irritation, an injection or bruise for instance, leads to the local formation of an extra-skeletal lump of bone. Surgical excision of the knot leads to more bone formation. The condition begins in childhood, gradually stiffens all joints in the spine and limbs, and makes even self-care activities impossible. Sadly, chewing and chest expansion become restricted, so either malnutrition or pneumonia causes early death.

The first malady discussed, hypophosphatasia, is far more common than the other two and is treatable. The others are exceedingly rare. Total worldwide cases number no more than a few hundred. Awareness of the three allows a glimpse into the amazing and complex life of normal bone, which is worthy of our utmost appreciation.  

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to be published by WW Norton, October 20, 2020

See contents, reviews, and endorsements for BONES

Serpent slithers from sea, meaning is ambiguous.

The Loire River, the longest in France, empties into the Bay of Biscay and the Atlantic Ocean near Nantes. There, the second longest sea serpent ever seen, 425 feet, morphs twice daily into a giant beach snake according to the level of the tide. Well, it’s not an entire dragon, but its skeleton leaves little other than skin color and a forked tongue to the imagination.

The aluminum sculpture is the creation of Huang Yong Ping, a compelling avant-garde artist. He was just the sort of original thinker who would make a sculpture that is partially submerged half the time. Ping made a similar reptilian sculpture, nearly twice as long, that he could fit into Paris’s Grand Palais only after snaking it around and over stacked shipping containers.

Ping, born in China, was a key figure in avant-garde art there. He moved to Paris in 1989, and in due time, both countries claimed him as their own. He lived in France until his death in 2019 at age 64. Just as his experience spanned continents, his giant serpents, central symbols in Chinese culture, blend cross-cultural concepts of creation, temptation, wisdom, deception, sexuality, good luck, prosperity, and rebirth. They link East with West as well as sky with water in ways that are open to personal interpretation.

Ping felt that “art could not be detached from real life, but should instead take a stand on everything” and that “it was the ideas rather than the objects that were the real works of art.”* To make this point, he and his fellow avant-gardians once assembled a show and then at the end set it afire. At other times, they would organize a museum exhibit and cancel at the last minute, undermining the curator’s authority on what was exhibited and when. Or consider his 20-ton replica of a British bank in China that later became a Communist government building. It was cast of sand mixed with thin cement and designed to slowly crumble, which it did. Westerners saw it as a critique of capitalism. The Chinese could interpret it as a sign of colonial weakness. A further example of his iconoclastic style was his A Concise History of Modern Art after Two Minutes in the Washing Machine. Ping literally churned two famous textbooks on Chinese art, one by a Chinese expert and the other by a Brit, and displayed the soggy mess on a wooden box.

Fortunately for bone lovers, his French beach serpent, Ressort 2012, is less ephemeral than some of his entirely outlandish works. Ressort in French means spring, in the sense of resilience and energy—aspirational qualities for our times, regardless of the tide.

*The Economist, November 9, 2019

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Book launch October 20, 2020. Available now for pre-order on Amazon

Have bones influenced automobile styling?

To begin answering this question, let’s start in 1948, the year that American automotive entrepreneur Preston Tucker introduced his Tucker 48. At a time when the major car manufacturers had not introduced new models since 1941, Tucker offered consumers previously unheard-of features on an American car. These included a padded dashboard, a rear engine, and a pop-out windshield made of shatterproof glass. The most distinctive feature was the central, directional headlight that would brighten the 48’s course around bends in the road.

The following year, the British car manufacturer, Rover, brought out its 75, an upmarket sedan, which also featured a centrally mounted headlight. Then in 1952, Italian car manufacturer Bertone showcased the Abarth 1500 Biposto (two-seater) at the Turin Motor Show. The car’s futuristic, aerodynamic styling included a central headlight and fins in the rear. The Packard Motor Company bought it, took it back to Detroit, and used it as design inspiration. Other manufacturers picked up on the styling, most notably Alfa Romeo, which made three concept cars named BAT (Berlinetta Aerodinamica Tecnica or Technically Aerodynamic Sports Coup) and displayed them in the 1950s. Other BAT concept cars followed, most recently in 2008. None, however, sported the Cyclops eye that distinguished the Tucker 48, Rover 75, and Abarth 1500.

Of course, the headlight was named for the Cyclopes, a tribe of one-eyed, uncouth, cave-dwelling giants who stood tall and fearsome in Greek and Roman mythology. Belief held that they lived in the Mediterranean region and built the ancient stone walls, which were otherwise unexplainable because the boulders were too large for men to maneuver.  As told by Homer, the best remembered Cyclops is the man-eating Polyphemus, whom Odysseus outwitted and blinded by driving a stake through its eye.

How do myths like this get started? Rather than just an entire fabrication, a thread of truth may become embellished with multiple retellings across generations. For instance, the legend of King Arthur probably started this way. The same may be true for Polyphemus and company. At the end of the last ice age, about 11,000 years ago, a species of five-to-seven feet tall dwarf elephant lived on Cyprus, Crete, Malta, and Sicily, among other Mediterranean islands. If an ancient shepherd stumbled across the skeleton of one of these junior jumbos and trundled its skull back to town, the opportunity for misinterpretation would be great. Compared to human skulls, which have well-defined, forward-facing bony eye sockets, an elephant’s eye sockets are open and are set farther back on the sides of its head. The purpose of these wide openings is not immediately clear. Furthermore, the dwarf elephant’s nasal opening is central and high on its skull in order to accommodate the trunk’s attachment.

Not being skilled in comparative osteology, perhaps ancient people misidentified this nasal opening as a single eye socket and named the mini behemoth Cyclops, “Round-eye”. Furthermore, the existence of a tribe of huge, one-eyed creatures roaming the Mediterranean region could explain the massive stone walls, still known as cyclopean walls. In 1914, an Austrian paleontologist and evolutionary biologist postulated such a factual basis for the Cyclops myth.

We will never know, but it is easy to imagine that the skull of a small, ancient elephant inspired automotive styling, which is reflected in modern sportscars’ aerodynamic styling even in absence of a central headlight. Maybe it’s a myth, but it’s a good story.

Patriotic Fossils

Frenchman George Louis Leclerc de Buffon was a preeminent naturalist of the late 18th century. Among his accomplishments, Buffon raised the ire of the Americans to an alarming level. He claimed that nature in the Americas was inferior to that in Europe, that the New World lacked large and powerful beasts, and that even the Native Americans were smaller, weaker, and generally inferior to Europeans. “There is not any animal in America that can be compared to the elephant, the rhinoceros, the hippopotamus, the dromedary, the giraffe, the buffalo, the lion, the tiger.” He attributed this lack of vigor to a foul climate where nothing could grow properly.

This came at a time when the Founding Fathers were encouraging Europeans to invest in the United States to strengthen the economy and support western expansion. Thomas Jefferson was livid and fought back by sending Buffon a New Hampshire moose to prove him wrong. Then he charged Meriwether Lewis to bring back evidence of mastodons from his discovery expedition to the Northwest. This stemmed from Jefferson’s interest in natural history and his awareness that, several years before Lewis’s and Clark’s departure, fossils of a nearly complete mastodon, previously unknown, had been unearthed in the Hudson River Valley. This discovery created quite a stir on two fronts. At the time the concept of extinction was incompletely formed and not widely supported. Scientists had trouble explaining these gigantic bones because there was an absence of any living counterpart. They named it American incognitum. Secondly and more importantly to the populace, the giant beast came to symbolize the United States’ conquering spirit and awesome power, particularly in face of Buffon’s vainglorious insult.

Charles Willson Peale, The Artist in His Museum, 1822
Pennsylvania Academy of Fine ARts
Note incognitum hiding behind the drapery

While Lewis and Clark were gone, portrait artist, naturalist, and entrepreneur Charles Wilson Peale purchased the mastodon’s fossils and then assembled and displayed them at his museum in Philadelphia. The creature became a public phenomenon, not so much for its scientific significance, but rather as an informal symbol of dominance and national identity for this new and psychologically insecure society.

At first Peale displayed the mastodon with its tusks pointed upwards, elephant-like. It was unknown whether incognitum was a carnivore or herbivore, but journal articles and pamphlets fanned the mania of its presumed terrifying nature. “Forests were laid waste at a meal, the groans of expiring animals were everywhere heard; and whole villages, inhabited by men, were destroyed in a moment.” Peale’s son, Rembrandt, remarked, “Gracious God, what a jaw! How many animals have been crushed by it?” He further described incognitum to museum visitors as “cruel as the bloody panther, swift as the descending eagle, and terrible as the Angel of Night.”  

The American Incognitum

With such hyperbole, it should not be surprising that Rembrandt heightened incognitum’s box-office attraction by turning its tusks down and arguing that they might have been used for “striking down small animals, or in detaching shell-fish from the bottom of rivers, or even in ascending their banks.” The tusks remained so positioned for at least another ten years.

Yet the myth persisted for decades. An 1839 novel, The Behemoth, portrayed the mastodon laying waste to the wilderness “as if it had been recently trampled by some angry and barbaric puissance, that had swept it from end to end like a storm.”

Ultimately, the Peales went bankrupt and sold incognitum to European collectors. The skeleton ended up in a museum in Darmstadt, Germany, where it can be seen, tusks up, today. Buffon eventually admitted his mistake about New World vigor.

Incognitum’s popular appeal as an icon of power and dominance has endured, now having morphed into a fantasy appeal for other monster predators, including dinosaurs and sharks. Paul Semolina* suggests that we take the frenzy that incognitum stirred up to “question our own casual acceptance of the paradigm of dominance. Such myths and metaphors often express our most basic values and beliefs. They are the mental constructs that need to be reinvented if we are to give cultural life to values other than those of violent conquest and domination.” Sage words for our times. Happy Fourth of July.

*http://commonplace.online/article/peales-mastodon-the-skeleton-in-our-closet/

Electric Scooters vs. Bones

One silver lining in the Covid-19 cloud is the sudden scarcity of electric scooters on the UCLA campus and surrounding areas, both in stationary jumbles and in erratic motion. Since the students are gone, Lime, Lyft, and Bird have quarantined their scooters, which has freed the sidewalks for … well … walking.

In September, 2017, standing electric scooters popped up first in nearby Santa Monica and quickly spread to more than 100 cities around the world. Six months after introduction, Bird announced the completion of its one millionth ride. In most instances, the scooters just popped up overnight without any go-ahead from local governments or announcements from the start-ups.

The mantra for many venture-capital endeavors is, “Move fast and break things.” In other words, introduce a disruptive technology, and after it has gained some mass appeal, ask for forgiveness for any legal overreach rather than bog down the launch by seeking pre-approval. Uber is such an example.

For electric scooters, however, “move fast and break things” has a literal meaning as well, the “things” being bones. Investigators recently reported the first year’s experience in emergency rooms for the two main hospitals in the UCLA system.* They first excluded injuries when a scooter was used as a weapon and incidences involving attempted scooter theft. (What a humdrum life the rest of us lead.)

When I took this photo, I did not appreciate the irony: scooters, bus, hospital.

Of the 249 remaining injuries, nearly 60% involved men. The average age for the fallen was 34 years, (range 8-89, yes 89—nothing humdrum there), and 11% of injuries were in patients younger than 18, the minimum age to e-scoot. Ninety-two percent of the patients were riders, the others either stumbled over a scooter, were struck by one, or were injured while lifting or carrying one. I am not sure why somebody would want to carry one, but maybe it was because the five percent of the patients reported to have been drinking got mixed up. Only 4% of patients were known to be wearing a helmet.

Forty-two percent of patients experienced either a fracture or dislocation. Wrist fractures were the most common, but other portions of the limbs along with the face and spine were also represented. Forty percent sustained head injuries. Fortunately, all but two were minor. Unfortunately, two were not. Lacerations, scrapes, bruises, and internal injuries to the chest or abdomen also took their toll.

To put these 249 injuries into perspective, during the same time period, these two emergency rooms treated 181 pedestrian and 195 bicycle injuries, although these activities are intuitively far more common than e-scooting.  

So when the pandemic has passed, electric scooters will undoubtedly spring up again as a popular and convenient conveyance as well as a modern way to break bones and knock heads. Several safety innovations are under consideration. One would be to geofence areas of high pedestrian traffic where an electronic signal would incapacitate encroaching scooters. Another would be to provide a helmet and disposable liners with each vehicle. Nothing has been said yet about sobriety or common-sense testing prior to launch. Before the lockdown, two people riding together were common sightings. The most unsettling one for me, however, was the sight of a man with a two-year-old on his shoulders and another slightly older child riding in front of him. Not a helmet in sight. Surely the “adult” could not have been the kids’ father. Maybe contacting Covid-19 is inevitable, but avoidance of contacting the pavement begins with exercising. Exercising common sense. Stay safe.

*JAMA Network Open. 2019:2(1)e187381.

How bone lovers pasta time.

Since the pandemic started, the news media note that pasta has been flying off grocery store shelves almost as fast as hand sanitizer and toilet paper. Certainly pasta is cheap, easy to cook, and filling; and throwing hot pasta against the wall to test its doneness has to be stress relieving.

But there may be another reason for pasta’s scarcity, which an AboutBone blog reader tipped me off about—craft projects. She sent me an image of a pasta skeleton, which had been forwarded to her. She did not know its provenance, so I was hesitant to post it without being able to attribute the artist, because even pasta artists have intellectual property rights.

I stewed over the issue for several days, and then during my next early-morning, biweekly foray to the grocery store, I scored eight boxes of pasta from the sparsely stocked shelves. Each box contained a different shape of hard, whitish construction material, faintly reminiscent of tiny bones. So here are examples to inspire you should you and your kin tire of baking bread and assembling jigsaw puzzles.

Send me a picture of your masterpiece, either gluten-laden or gluten-free, and I will include it in a future post.

Meet George Stubbs: anatomist, artist, animal lover, lifter of human spirits

Whistlejacket

I learned about George Stubbs several months ago when I was looking for an image of a horse to illustrate a blog post. I came across the stunning painting of Whistlejacket, which hangs in the National Gallery in London.

Englishman George Stubbs did not arrive at his impressive talent easily. He taught himself to paint and developed a mastery of portraying horses by meticulously dissecting and drawing the anatomy of a dozen of them over 18 months in the mid 18th century. He particularly focused on their bones, muscles, and subcutaneous veins to arrive at “authentic, elegant and transcendental paintings.*” Michelangelo had achieved equal mastery of the human form by similar means 200 years earlier; but Stubbs went even further. Finding no suitable engraver, he taught himself to etch “to the necessary standard” and made the plates for his book, The Anatomy of the Horse.

The Anatomy of the Horse

Although the book was a marvel of detailed equine anatomy rarely found in human anatomical works of the time, Stubbs saw himself as an artist rather than as an anatomist. He identified himself on the title page as George Stubbs, Painter. In the introduction he hoped that the book “might prove particularly useful to those of my own profession” and took care to portray his specimens in lifelike positions.

Stubbs developed an aristocratic patronage and lived well in London on commissions received from painting both humans and racehorses.

He also started a second book, Comparative Anatomical Exposition of the Structure of the Human Body, with That of a Tiger and a Common Fowl. Unusual for the time, the drawings of these animals, which were externally quite different, demonstrated marked, shared skeletal similarities.

Comparative Anatomical Exposition of the Structure of the Human Body, with That of a Tiger and a Common Fowl

Stubbs became friends with brothers William and John Hunter, both eminent doctors. The three of them shared their deep interests in anatomy and the natural world. The Hunters greatly valued Stubbs’ artistic expertise because, as Britain’s colonial expansion brought home growing knowledge of the natural world, visual records were vital for identifying species and distinguishing differences between them. For instance, Stubbs had opportunities to visit aristocrats’ country estates, which often had menageries. On one visit he accurately painted a moose, rarely seen in Britain at the time. William Hunter was then able to compare the moose to the fossilized skeleton of an Irish elk, which was actually a deer with gigantic antlers. At the time, some considered the moose and the Irish elk to be the same species, but Stubb’s painting showed that the moose’s recently shed antlers were distinctly different from the fossilized Irish elk antlers. This evidence helped William Hunter show that the two animals were distinct species and that the elk was extinct, a then controversial concept.

Through his paintings of other privately kept wild animals, Stubbs introduced 18th century Britons to kangaroos, lions, tigers, rhinos, and giraffes.

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Even with horses and dogs, each animal’s spirit seems to jump off the canvas and into viewers’ hearts. George Stubbs made the point that, despite first-glance appearances, we have much in common with animals larger, smaller, and more furry and feathery than ourselves.

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* Spira A, Postle M, Bonaventura P (editors): George Stubbs, All Done from Nature. London, Holberton Publishing, 2019.

Extra-terrestrial bone can distract us from earthly woes.

Bone has been around for 500 million years, and a small fraction of it has been preserved as fossils—stone bones. Bone in another form, charcoal, has a shorter but extremely dark history, which extends into popular culture and space exploration. Variously known as bone charcoal, bone black, and bone char; it is produced by burning bones, byproducts of the meatpacking industry, in an oxygen-starved environment.

Almost 40,000 years ago, cave artists drew with charcoal made from either wood or bone, and Egyptian tomb painters used it about 5000 years ago. Why the ancients chose one type of charcoal over the other is unclear, but their properties do differ. Wood charcoal is blacker and is now known to be carcinogenic when ingested. Without realizing that the alternative was toxic, Hippocrates recommended bone char for treating epilepsy, anthrax, gangrene, and bad breath. (Black tongue, anyone?)

About 1800, someone discovered that pouring vinegar or wine through a bed of bone char clarified the liquid. It was soon revealed that bone char would do the same for sugar syrup, refining brownish raw sugar and making it white. The sugar industry could not get enough of it, and pioneers prospered by picking up and selling bleached bison bones that littered the American prairies to sugar refineries. (These bones were also a much-in-demand raw material for the fertilizer industry. See https://aboutbone.com/when-bone-piles-became-cash-cows )

Presently various industries use bone char to color linoleum, paint, printing ink, wallpaper, plastic, and concrete. Also, Hollywood has casted bone char as a nontoxic stand-in for oil slicks and spills in movies including On Deadly Ground, Beverly Hillbillies, Die Hard III, Waterworld, Down Periscope, and Men in Black. In other productions it has also mimicked mud and lava.

On Deadly Ground

The truly out-of-this-world applications for bone char, however, relate to satellites. Launched in 1977, Voyager I and II have some of their optical components coated with bone char. These satellites are two of only several Earth objects that have left the Solar System, and both are expected to maintain some functions until at least 2025. They will continue to drift intergalactically at minus 455 degrees Fahrenheit until eventually some distant star vaporizes them or a black hole engulfs them—extraordinary trips for some cow and pig bones.

At the opposite end of the thermal spectrum, the Solar Orbiter, a European Space Agency/NASA joint venture,  took off on its seven-year mission in February 2020. During the next two years, the satellite will position itself into a solar orbit closer than Mercury’s to explore the previously poorly observed solar poles. In doing so, it will experience light intensity 13 times that present on Earth and temperatures as high as 1000 degrees Fahrenheit. (Image putting your cell phone in an extremely hot oven and doubling the temperature.)

An eight-by-ten foot heat shield on the face of Solar Orbiter will protect the delicate scientific instruments from the Sun’s withering heat and light and allow them to function at a constant temperature. During planning, requirements for the shield included a surface that, over the course of the mission, would not flake off or fade from intense ultraviolet light. It could not emit vapors or build up static electric charges because either would distort the instruments’ measurements. The shield also had to be light weight in order for the satellite to escape Earth’s gravity at the journey’s onset.

The shield is made of titanium foil which is permanently bonded to a thin layer of, you guessed it, bone char. It proved best in meeting all the requirements; and yes, black does absorb heat, but bone char quickly radiates it away. Furthermore, the shield is positioned four inches in front of the satellite’s main body, allowing for adequate ventilation. Small openings in the shield allow cameras and other sensing devices to momentarily stare directly at the Sun before their overlying “eyelids” blink closed.  

Between now and 2027, the ten onboard instruments (one from the US and the others from individual European countries) will have a lot to tell us about solar winds and geomagnetic storms. They reach Earth in their mildest forms as aurora phenomena (northern and southern lights). In their harshest forms they could create havoc in our electrical systems, which could knock out satellites, GPS, electrical grids, and computer networks. So we should take a personal interest in the success of the high-tech Solar Orbiter, whose fate relies on humble bone.   

Do viruses infect bones?

Viruses typically invade our bodies through an opening. Think gastrointestinal flu, Covid-19, AIDS. Our bones, however, are normally protected from any outside exposure, so they should be safe, right?

The short answer is yes and no. Of course knowledge is power, and we need both right now, so here is a nuanced answer.

Patients with smallpox complained frequently of bone pain. Epidemics in Prague in 1891-1892, in Boston a decade later, in the Philippines a few years after that, and in India in the 1940s led investigators to conclude that bone and joint changes appeared in approximately 1% of infected adults and 5% of infected children. The elbows were affected in 80% of cases, hands and wrists in 20%, other areas less commonly. Over half of these patients had more than one joint affected. In children, the affliction frequently halted the development of growing bones, leaving some remarkably short.

The good news is that the World Health Organization declared the worldwide eradication of smallpox in 1980. This came about by vaccinating populations with smallpox’s less virulent cousin, cowpox, imparting immunity to both. (Cow in Latin is vacca, hence the origin of the word vaccine). In areas where most people had been vaccinated, infections became rare, and routine immunization ended in the US and Western Europe in the early 1970s and worldwide in 1986.

People also got bone infections from chickenpox, but those were most likely caused by bacteria that entered the bloodstream through itchy skin blisters and scabs. Fortunately, chickenpox has become extremely rare since the advent of a vaccine in the 1990s.

The same is true for two other viral diseases that many people, myself included, tend to confuse: German measles and measles, also known respectively as rubella and rubeola (as if that clarifies things). Rubella causes milder symptoms than rubeola, but when the rubella virus passes from a pregnant woman to her fetus, the devastation includes heart defects, learning disabilities, and bone weakening, especially around the knee.

Rubeola, conversely, made patients more miserable at its onset, but it usually left bones alone. Fifty to eighty years later, however, some people developed Paget’s disease, also known as osteitis deformans, which even without much knowledge of Latin suggests its nature: excessive bone breakdown followed by disorganized new bone formation. Investigators have recently found a rubeola virus protein in the bone-remodeling cells in people with Paget’s disease. To study the possible link further, the researchers genetically engineered mice to harbor this viral protein in their bone cells. The mice developed Paget’s disease. On a positive note, the human incidence of Paget’s disease of bone has declined in recent decades, which coincides with the introduction of a rubeola vaccine in 1969.

Other viruses can cause aching muscles and swollen joints but do not seem to affect bone. Notorious ones of this sort cause dengue fever. It is also known as breakbone fever because it causes excruciating muscle aches. One victim related, “You don’t die from it, but you wish you could.” There are five forms of this virus, and surviving one form imparts long-term immunity from it but not the other forms. A vaccine that covers four of the varieties is available. Dengue viruses still infect almost 400 million people annually, mostly in Africa and South America. It is lethal for one person in ten thousand (40,000 per year), most often young children, whose immune systems are not fully developed.

So back to the question, do viruses infect bone? And more broadly, are there lessons here to apply to the current Covid-19 pandemic? Yes and yes. Some viruses historically have affected bone, but there are vaccines available to prevent such diseases entirely. Covid-19 causes muscle aches, but nothing so severe as those encountered with breakbone fever, and only time will tell whether the novel corona virus will cause bone manifestations, which may not be revealed for decades. A vaccine will become available against Covid-19, and we can hope that one form will suffice in contrast to the multiple forms needed to prevent dengue fever.

Certainly the current pandemic is devastating on many levels, but here is some perspective. Smallpox vexed people for well over 2000 years and killed 300 million people in the twentieth century. The Spanish flu killed up to 100 million people worldwide and nearly 700,000 Americans in just a few years. Ordinary seasonal influenza kills 300,000 to 650,000 people a year including 60,000 Americans. Dengue fever is agonizingly painful and kills young children. Until the 1950s, the causes for these drastic diseases were unknown, no testing was available, and there were zero test kits, intensive care units, and respirators. So despite present and fully justified concerns, we (including our bones) have a lot to be thankful for.

Stay immunized. Stay separated. Stay safe.

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