Reading:: Hyperostosis in Females

Rate of Occurrence, Gross Appearance, and Age Relation of Hyperostosis Frontalis Interna in Females: A Prospective Autopsy Study

By Nikolic´, Slobodan MD, PhD,* Djonic´, Danijela MD, PhD,† Z˘ivkovic´, Vladimir MD, MSc,* Babic´, Dragan MD, PhD,‡ Jukovic´, Fehim MD,§ and Djuric´, Marija MD, PhD†

This article is about a study to find out the occurrence rate of hyperostosis frontalis interna (HFI) in females and to determine if there is a correlation of occurrence with age. Although HFI was first described in the 18^th century by Morgagni, it seems to be primarily a 19^th and 20^th century occurrence as it is very rarely discovered in historic populations. The most common causes of HFI are functional disturbances of the gonads, ie, faulty estrogen stimulation or inadequate androgen stimulation by tests. It could also be caused by obesity, arterial hypertension, or genetic predisposition. HFI is often associated with headaches, epilepsy, and dementia. Because hyperostosis progresses very slowly over many years the body is able to activate coping mechanisms, which means there is no sudden onset of symptoms.

There were 248 female individuals included in the sample. During the autopsies the cranial vaults were opened according to standard procedure by way of a cut from the glabella to the occipital protuberance. Macroscopic analysis was performed using Herschkovitz et al’s standard criteria for HFI stage classification, which includes 4 stages of manifestation. Of the 248 deceased females in the study, only 45 presented with HFI. Also, 1220 male craniums were analyzed but only 9 actually had the HFI. Following is a table showing the female distribution of HFI in respect to age groups:

HFI Type				Age (year) <<<|>>>
	<20	21-30	31-40	41-50	51-60	61-70	71-80	>80
Absent	9	19	16	23	31	36	42	27
A	1	1	0	0	1	1	2	1
B	0	0	0	2	3	2	5	2
C	0	0	0	0	1	5	10	3
D	0	0	1	0	1	1	1	1
Total	10	20	17	25	37	45	60	34

Altogether, they discovered an HFI occurrence rate of 3.68% (1468 individuals), and a female rate of 18.14% and .07% in males. According to Herschkovitz et al, the earliest stage of HFI can occur in females as young as 21 years old, while the matured stage of HFI does not appear before the age of 40. HFI occurrences do increase with age and are more common among females now, when compared with older studies. Since post-menopausal women have the highest occurrence rate of HFI, Nikolic et al deducts that it may be associated in some way with hormonal status. While more direct and specific causes of the hyperostosis still need to be studied, Nikolic et al has at the very least established that the occurrence of HFI does have a correlation with age in females.

Reference: 

Nikolic´, Slobodan MD, PhD,* Djonic´, Danijela MD, PhD,† Z˘ivkovic´, Vladimir

             MD, MSc,* Babic´, Dragan MD, PhD,‡ Jukovic´, Fehim MD,§ and 

             Djuric´, Marija MD, PhD† (2010). Rate of Occurrence, Gross 

             Appearance, and Age Relation of Hyperostosis Frontalis Interna in 

             Females: A Prospective Autopsy Study. American Journal of Forensic 

             Medicine and Pathology; 31(3); 205-207.