The diagnostic value of microscopy in dry bone palaeopathology: A review

• The value of histology as a diagnostic tool is the subject of ongoing discussion.
• All histological diagnostic efforts in human dry bone were reviewed systematically.
• Results show that few disorders present a ‘pathognomonic’ histomorphology.
• Conclusions on the additional value of histology are offered per disease category.

Over recent decades histology has increasingly been used as a diagnostic tool in human dry bone palaeopathology. Still, the use of histology in human dry bone is associated with various problems, including a lack of pathognomonic histomorphology and a need for more experimental data. Consequently, the value of histology as diagnostic tool in human dry bone remains a subject for debate.Here we review all published palaeohistopathological research in human dry bone. A systematic search identified 3363 articles, with the 64 most relevant citations studied in depth. We specifically focused on the interpretation of histomorphological parameters and the use of comparative fresh bone tissue and/or experimental data.Our literature review shows that only a few disorders demonstrate a ‘specific’ histomorphology: Paget's disease, osteoporosis, hyperparathyroidism and possibly osteomalacia. In all other cases, histology may aid during the differential diagnostic process, but it is unable to confirm a definitive diagnosis. The histological diagnostic process and consequential recommendations for the use of histology are discussed per following disease categories: metabolic disease, neoplasm, infectious disease and trauma.