Age-related disease or disease-related age? Perspectives for paleopathological research

OBJECTIVE: The interconnection of biological aging and disease throughout the life course profoundly affects almost every aspect of paleopathological research but is rarely explored. This paper presents a theoretical and practical framework for an informed research approach that explicitly acknowledges these complex interrelationships. METHODS: We discuss the existing concept of age-related disease and introduce the new concept of disease-related age. Their relevance and practical applicability are demonstrated through selected paleopathological examples, which propose modifications to existing practice and avenues for future research. CONCLUSION: Diseases and pathological lesions influence the ability to estimate skeletal age at death, whilst our inability to accurately estimate age and death affects our ability to understand past disease. By incorporating consideration of age-related disease and disease-related age into paleopathological research, alongside adopting specific methodological approaches, we will significantly improve our understanding of both past disease and past demography. SIGNIFICANCE: We offer the first comprehensive assessment of the nature and implications of skeletal age-disease interrelationships and their impact on researching past health and disease. LIMITATIONS: This paper is the first step forward in engaging with the complex, but critically important, issues of the inter-relationship of age and disease in paleopathology. SUGGESTIONS FOR FURTHER RESEARCH: The nature of the interaction between pathophysiology and aging processes and its osseous manifestations require further interdisciplinary research, both on a case-specific and systemic level. Results will need to be integrated into osteobiographical, paleodemographical, and paleoepidemiological studies.