Evidence of Skeletal Fluorosis at the Ray Site, Illinois, USA: a pathological assessment and discussion of environmental factors

Elizabeth A. Nelson, Christine L. Halling, Jane E. Buikstra

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Objective:: To carefully assess skeletal lesions in close environment context in order to evaluate whether skeletal fluorosis was present in individuals living in the prehistoric Midwest, USA. Materials:: Skeletal remains from minimally 117 individuals recovered from the Ray Site, located in western Illinois (USA) and dated to the Middle/early Late Woodland periods (50 BC-AD 400). Methods:: Macroscopic evaluation of all recovered skeletal elements. Results:: Eight individuals display a constellation of abnormal bony changes, including osteosclerosis, a high frequency of fractures, and dental abnormalities. Conclusions:: The osteosclerotic changes along with the naturally high fluoride content of west central Illinois soil and water suggests the presence of skeletal fluorosis. Significance:: This is the first report of skeletal fluorosis from archaeologically recovered human remains from North America. Limitations:: The ambiguous nature of the skeletal changes associated with fluorosis, especially in the less severe stages of the disease, renders determination of the etiology difficult. Suggestions for Further Research:: The continuation of paleopathological investigations of fluoride toxicity within archaeological communities recovered from this region with emphasis on the incorporation of biomedical and environmental data. Furthermore, complementary analyses of the chemical composition and the histological presentation of the skeletons could provide support for this diagnosis.

Original languageEnglish (US)
Pages (from-to)48-60
Number of pages13
JournalInternational Journal of Paleopathology
StatePublished - Sep 2019


  • Differential Diagnosis
  • Fluoride toxicity
  • Metabolic Bone Disease
  • North America

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Archaeology


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