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Metamorphosis at the sternal rib end A new method to estimate age at death in white males.

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AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 65:147-156 (1984)
Metamorphosis at the Sternal Rib End: A New Method to
Estimate Age at Death in White Males
M. YAQAR IQCAN, SUSAN R. LOTH, AND RONALD K . WRIGHT
Department OfAnthropology, Florida Atlantic University, Boca Raton,
Florida 33431 (M. Yl., S.R.L.); Broward County Medical Examiner’s Office,
Ft. Lauderdale, Florida 33312 (R.K.W )
KEY WORDS Ribs, Costochondral junction, Sternal end
ossification, Aging, White males
ABSTRACT
While the pubic symphysis and intracortical morphometry
have provided successful results in estimating age a t death, other methods and
sites in the skeleton are needed to improve the accuracy of age estimation.
This research is a n attempt to develop a new age-determination technique by
using the sternal extremity of the rib. The right fourth rib was collected at
autopsy from 93 white males. The sternal extremity of each rib was analyzed
in relation to the pit depth (component 0, pit shape (component II), and rim
and wall configurations (component 1111, each of which was divided into six
stages. Results indicated that the age a t death can be estimated from a rib
within about 2 years in the second decade to about 7 years in the fifth and
sixth decades of life. Pit shape and rim and wall configurations yielded better
results than absolute pit depth alone. While this method has a potentially
important contribution to skeletal anthropology, factors such as sex differences
and biomechanical variation between individuals may affect the determination of age from the rib.
Although techniques for the determination
of skeletal age a t death have improved from
the limited success provided by analysis of
cranial sutural closure to the more reliable
results obtained from symphyseal changes in
the pubic bone (Stewart and Trotter, 1954;
McKern and Stewart, 1957; Krogman, 1962;
Acsadi and Nemeskkri, 1970) and microscopic evaluation of intracortical remodeling
in the long bones (Kerley, 1970; Thompson,
1979) additional methods are still being
sought. The present study is a n attempt to
develop a new method to determine age from
the sternal end of the rib by using a controlled sample of individuals of known sex,
age, and race.
This attempt to determine age from the rib
was based on evidence provided by radiographic, histologic, and osteological studies.
Radiographic analyses have focused mainly
on mineralization of the costal cartilage and
its apparent increase with age (Nishino, 1969;
Semine and Damon, 1975; McCormick, 1980).
Histologic studies have been primarily concerned with bone remodeling in the rib (Sed-
0 1984 ALAN R. LISS. INC.
lin et al., 1963; Epker et al., 1965; Frost,
1976). These studies indicated that the medullary cavity of the rib enlarges and periosteal bone deposition continues throughout
life at a faster rate than periosteal resorption. However, this process was outstripped
by a n increase in endosteal resorption, resulting in the progressive thinning of the
cortex of the bone (Epker et al., 1965). At the
gross anatomy level, Kerley (1970) and Ubelaker (1978) have briefly alluded to age-related metamorphoses in the sternal
extremity of the rib. Kerley (1970) noticed
that the joint surface is billowy in adolescence, while margins are sharp and cupshaped in middle aged adults, and irregular
in old age.
Based on this information and our own observations, it was thus expected that the rib
would show age related metamorphosis observable by gross examination of the bone. A
survey of the literature and reference sources
Received July 14, 1983; revised June 4, 1984; accepted June 5,
1984.
148
M.Y. ISCAN, S.R. LOTH, AND R.K. WRIGHT
in forensic and physical anthropology have
indicated that this part of the rib has not
been analyzed in depth by direct examination (Levine, 1971; Eckert and Noguchi, 1974;
Semine and Damon, 1975; McCormick, 1980;
Igcan, 1983). Apart from the aforementioned
studies, the sternal end of the rib has been
neglected in spite of its potential suitability
as a viable site for age determination from
skeletal remains.
MATERIALS AND METHODS
To observe age-related changes, the sternal
end of the right fourth rib was collected from
white males autopsied a t a medical examiner's office. All adherent soft tissues, including the costal cartilage, were easily removed
from the bones after the specimens had been
soaked in water for several weeks, then
boiled gently for 10-15 minutes.
The sample consisted of 93 specimens. Only
those individuals 17 years and older were
included in the analysis because morphologic
metamorphosis a t the sternal end of the rib
were not observed until this age. Table 1
shows the frequency of specimens in each age
interval. Approximately 75% of the sample
were under the age of 50. Furthermore, it
should be noted that the highest concentration by age was in the twenties (34%). The
mean age of the sample was 38 years.
A system of component analysis, analogous
to that used by McKern and Stewart (19571,
was developed to quantify the metamorphoses observed at the costochondral junction. Each rib was examined with special
attention to three factors (components) where
changes were most noticeable, i.e., pit depth,
pit shape, and rim and wall configurations.
Data were analyzed statistically using SPSS
programs CROSSTABS, BREAKDOWN, and
ONEWAY analysis of variance (Nie et al.,
1975; Hull and Nie, 1981).
Component I: pit depth
One of the most obvious age-related
changes observed is the formation and deepening of a cavity (pit) at the sternal end of
the rib. The maximum depth of this pit is
measured with a depth caliper calibrated to
0.1 mm. This measurement is taken where
the distance between the base of the pit and
the adjacent anterior or posterior wall is the
greatest. The caliper is held perpendicular to
the base of the pit. The cranial and caudal
sides of the rib end are not used because of
the presence, in some specimens, of long projections of bone. These projections are consid-
TABLE 1. Age Distribution
of
specimens in the sample
Age intervals
(in vears)
N
0-16
17-19
20-29
30-39
40-49
50-59
60-69
70 and over
9
7
29
12
15
8
7
6
9.7
7.5
31.2
12.9
16.1
8.6
7.5
6.5
Total
93
inn n
O/n
ered by many earlier researchers such as
Fisher (1955)and Semine and Damon (1975)
to be more closely associated with sex than
age, and more recently aErmed by McCormick and Stewart (1983).
Component I is divided into the following
six stages (Fig. 1):
0. Flat to slightly billowy extremity with
no indentation (pit) greater than 1.1 mm
1. Definite pit formation with a depth ranging from 1.1 to 2.5 mm
2. Pit depth ranging from 2.6 to 4.5 mm
3. Pit depth ranging from 4.6 to 7.0 mm
4. Pit depth ranging from 7.1 to 10.0 mm
5. Pit depth of 10.1 mm or more
Component II: p i t shape
Component I1 deals with changes in the
shape of the pit. Initially, the pit is only a
slight, amorphous indentation, which in
about 1year from its first appearance, develops into a structure which is V-shaped. This
V-shape is formed by the posterior and anterior walls of the rib. Over the next few years
the base of the V widens to become U-shaped.
As age increases the walls of the pit grow
thinner forming a progressively wider U.
Component I1 is divided into the following
five stages (Fig. 2):
0. This stage is used for juvenile and adolescent specimens with no pit formation at
the flat or billowy articular surface.
1. A shallow, amorphous indentation (pit)
is now present.
2. Formation of a V-shaped pit with thick
walls.
3. The pit assumes a narrow U-shape with
fairly thick walls.
4. Wide U-shaped pit with thin walls.
5. The pit is still a wide U-shape, yet deeper,
more brittle, and poorer in texture with some
disintegration of bone.
METAMORPHOSIS AT THE STERNAL RIB END
Fig. 1. Component I-Pit depth. 0-stage 0. Note
nearly flat, billowy surface. There is no pit formation.
1-stage 1. Pit has formed to a maximum depth of 1.6
mm. 2-stage 2. Pit depth is 3.7 mm. 3-stage 3. Pit
149
depth is 6.1 mm. 4-stage 4. Pit depth is 7.4 mm. The
bony projection on the superior border of the rib is not
included in the measurement. 5-stage 5. Pit depth has
reached 11.1mm.
150
M.Y. ISCAN, S.R. LOTH, AND R.K. WRIGHT
Fig. 2. Component 11-Pit shape. 0-stage 0. This
specimen shows no pit formation at the nearly flat, billowy medial articular surface. 1-stage 1. Newly forming amorphous pit is obvious between the anterior and
posterior walls. 2-stage 2. A V-shaped pit formed by
the anterior and posterior walls. 3-stage 3. A narrow
U-shaped pit with fairly thick walls. 4-stage 4. A wide
U-shaped pit with thinning walls. 5-stage 5. A wide
U-shaped pit exhibiting brittle texture, very thin walls
and some disintegration of bone.
METAMORPHOSIS AT THE STERNAL RIB END
Fig. 3. Component ID-Rim and wall configurations.
0-stage 0. Note smooth, rounded rim and no wall formation. 1-stage 1. Rim still smooth and rounded with
incipient wall formation defining the shallow pit. 2stage 2. Scalloped or slightly wavy rim forms the edge
of thick, dense walls with smooth surfaces. 3-stage
3. Scallops are disappearing and the rim is becoming
151
more irregular. Walls are thinning but still fairly dense
and smooth. 4-stage 4. Rim is becoming sharper and
increasingly irregular. Walls are thinner and less dense
with noticeable deterioration in texture. 5-stage 5. Rim
is very sharp and highly irregular with frequent bony
projections. Walls are very thin, brittle and porotic with
deteriorating texture.
152
M.Y. ISCAN,S.R. LOTH, AND R.K. WRIGHT
Component IIE rim and wall configurations
Component I11 analyzes changes in the configurations of the rim and walls of the pit.
The rim starts out as a smooth, regular border around the pit that rapidly assumes a
scalloped but still fairly regular shape. Eventually, with advancing age the rim and walls
become increasingly irregular, thin and
sharp.
Component I11 is separated into the following six stages (Fig. 3):
0. The 0 designation is for those specimens
with a smooth regular rim and no wall
formation.
1. Beginning walls with a thick, smooth
regular rim.
2. Definitely visible walls that are thick
and smooth with a scalloped or slightly wavy
rim.
3. A transitional stage between the regularity in stage 2 and the irregularity in stage
4.The scalloped edges are disappearing and
the walls are thinning, yet the walls remain
fairly sturdy without significant deterioration in the texture of the bone.
4. The rim is becoming sharper and increasingly irregular with more frequent bony
projections often most pronounced at the cranial and caudal margins of the rib. The walls
show further thinning and are less sturdy
with noticeable deterioration in texture.
5. The texture shows extreme friability and
porosity. The rim is very sharp, brittle and
highly irregular with long bony projections.
Occasionally, as the depth of the pit increases, windows are formed in areas where
the walls are not complete.
RESULTS
Table 2 contains the descriptive statistics
and 95% confidence interval of the mean for
the components, individually and in toto.
Based on the five stages considered in the
analysis of component I (pit depth), the mean
age increased by 10 years or more from stage
1 through stage 4. Pit depth alone did not
prove to be a good indicator of age after the
fifth decade. The range of the 95% confidence
interval showed a gradual increase in stages
1through 3 and a marked increase in stages
4 and 5, representing individuals over 50.
Table 2 also shows the same analyses of
components I1 (pit shape) and I11 (rim and
wall configurations). In both of these components, the mean age rose 5 to 8 years in
stages 1 through 3, then increased to over a
decade in stages 4 and 5. This suggested that
change occurs more rapidly prior to age 30.
The 95% confidence interval also increased
with age but was much narrower than in the
previous component.
Following the individual analysis of each
component, they were summed (components
I + I1 + 111) to obtain a total score per rib
(Table 2). These scores ranged from 3 to 15,
and the mean age per score increased from
17 to 64.Inconsistencies occurred only with
scores of 12 and 15 and did not exceed 1 and
6 years, respectively.
The results of the analysis of variance and
related statistics appear in Table 3. Components I1 and I11 attained the highest F-ratios,
indicating that they are more age dependent
than component 1. The F-ratio for the total
TABLE 2. Summary statistics for the components
Stage
or
Mean
score N age
SD
95% Confidence
interval
Age
SE
ofmean
range
I-Pit deoth
1
9 20.3 3.32 1.11
2 29 30.7 12.40 2.30
3 31 40.9 13.72 2.46
4
9 55.0 15.39 5.13
5
4 57.5 12.92 6.46
Total 82 37.9 16.15 1.78
11-Pit shape
1
4 17.3 0.50 0.25
2 15 22.8 3.28 0.85
3 28 30.5 9.61 1.82
4 22 47.1 11.61 2.48
5 15 61.6 12.94 3.34
Total 84 38.4 17.26 1.88
111-Rim and wall configurations
1
5 17.8 1.30 0.58
2 25 24.1 3.55 0.71
3 20 34.3 11.62 2.60
4 16 49.5 11.21 2.80
5 16 58.2 11.53 2.88
Total 82 37.8 16.67 1.84
Total component scores
3 17.0 0.00 0.00
3
4
2 19.0 i.4i 1.00
4 22.5 3.32 1.66
5
7 23.1 4.06 1.53
6
3.63 1.05
7 12 24.9
9 27.0 4.90 1.63
8
9 10 37.8 13.21 4.18
8 47.1 12.03 4.25
10
6 48.5 9.89 4.03
11
12
7 47.6 11.75 4.43
13
5 56.0 10.32 4.61
14
4 63.5 12.26 6.13
4 57.5 12.92 6.46
15
84 37.3 16.81 1.83
Total
17.8-22.9
26.0-35.4
35.8-46.0
43.2-66.8
36.9-78.1
34.8-40.9
17-25
18-64
21-67
32-76
44-70
17-85
16.5-18.0
21.0-24.6
26.8-34.3
41.9-52.2
54.4-68.8
34.7-42.2
17-18
18-30
19-66
26-67
44-85
17-85
16.2-19.4
22.7-25.6
28.9-39.7
43.5-55.5
52.0-64.3
34.2-41.5
17-20
18-31
21-66
32-71
43-76
17-76
17.0-17.0
17.0-31.7
17.2-27.8
19.4-26.9
22.6-27.2
23.2-30.8
28.3-47.3
37.1-57.2
38.1-58.8
36.7-58.4
43.2-68.8
44.0-83.0
36.9-78.1
33.8-41.0
17-17
18-20
18-25
18-30
19-31
21-36
24-66
30-64
41-67
32-67
44-7 1
52-76
44-70
17-76
METAMORPHOSIS AT THE STERNAL RIB END
TABLE 3. ONEWAY analysis of variance of the
components
Sources of
variation
Sumof
d.f. squares
I-Pit depth
4 8,691.24
Between
stages
Within stages 78 12,438.28
Total
81 21,129.51
11-Pit shape
4 16,906.71
Between
stages
Within stages 79 7,817.53
Total
83 24,724.24
111-Rim and wall
Between
4 15,764.18
stages
Withyn stages 77 6,758.08
Total
81 22,522.26
Total component scores
Between
12 15,372.15
scores
Within scores 68 5,750.46
Total
80 21.122.62
Mean
squares F-ratio '7
2,172.81 13.45" 0.41
161.54
4,226.68 42.71* 0.68
98.96
3,941.05 44.90" 0.70
87.77
1,281.01 15.15* 0.73
84.57
*Significant at P < 0.001 level or less
component scores was slightly higher than
component I, but lower than components I1
and 111. The F-ratio showed that the variation between stages was statistically significant in all components a t a probability level
less than 0.001.
Table 3 also contains the eta-squared (q2)
values. These are particularly important
since they explain the percentage of variation in the age variable that can be attributed to the metamorphoses chosen to define
the components. Component 111, individually, attained the greatest percentage (q2 =
70%). This was closely followed by component I1 (68%), with component I a distant
third. Combining all three increased this figure, only slightly, to 73%.
The CROSSTABS procedure provided the
frequency distribution of the components by
age interval (decade) (Table 4).This analysis
revealed that the majority of cases in each
decade fell into two stages or less for individual components. The sum of components
spanned a score range of 3 to 6 per decade.
(It must be emphasized that a score is not
equivalent to a stage.) The x2 test indicated
that the distribution was statistically significant for all components, individually and in
toto, a t a probability level less than 0.001.
This table also pinpoints the onset and
completion of a particular metamorphic stage
in relation to age. In component 11, for ex-
153
ample, stage 2 is primarily defined by the
formation of a V-shaped pit. This developmental feature starts in late adolescence, is
most active in the twenties, and slows down
and ceases by the end of the third decade. Of
15 specimens exhibiting this specific pit
shape, 2 individuals (13%)were late adolescents, 12 (80%)were in their twenties, and 1
(7%)was in his thirties. This same developmental approach can be extended to the other
morphologic features defining the components and further strengthens the association of these characteristics with age.
DISCUSSION
While previous research indicated that the
rib and costal cartilage show age-related
change, histologic studies have not been
geared to the development of a technique,
and radiographic works have not produced
one that could yield an accurate estimation
of age. Histologic studies by Sedlin et al.
(1963) revealed that the cross-sectional area
of the rib cortex increased rapidly until skeletal maturity. From the age of 20 to 35 years,
this area declined sharply and continued its
gradual decline after age 35. Epker and associates (1965) also dealt with cortical bone
loss. Their findings indicated that the cortex
became thinner with age but the actual diameter of the bone increased. While this information agreed with our own observations
of pronounced changes in bone density and
texture seen in the later stages of each component, histologic analysis of the cortex alone
did not appear suitable for precise age
determination.
Radiographic works in general have been
limited to rough correlations of age with increased mineralization of the costal cartilage. Since radiographic evaluation requires
the availability of a n intact sternal rib cage
including the cartilages, this type of analysis
could not be used on skeletonized forensic
and prehistoric cases. In addition to this limitation, these studies also did not result in
the development of a technique that would
yield accurate age estimation. Semine and
Damon (1975) and McCormick (19801, however, felt strongly that the costochondral
junction should be further studied and utilized as a n important indicator of age.
The present study was comparable to those
on the male pubic symphysis CMcKern and
Stewart, 1957). As in the pubic symphysis,
the metamorphic changes in the rib were
discernible from one stage to the next in each
12
29
12
'x2 = 70.02 with 24 degrees of freedom (significant at P < 0.001).
'x2 = 130.43 with 28 degrees of freedom (significant at P < 0.001).
3x2 = 118.15 with 24 degrees of freedom (significant at P < 0.001).
4x2 = 151.85 with 72 degrees of freedom (significant at P < 0.001).
29
2
2
4
2
1
1
12
29
1
3
5
10
7
3
2
8
2
20
8
1
7
4
12
1
29
7
4
6
2
30-39
12
16
1
5
16
8
20-29
4
3
17-19
1
4
2
2
1
3
4
5
Total
7
Total N
N
7
111-Rim and wall configuration3
1
4
3
2
3
4
5
7
Total N
Total component scores4
3
3
4
1
5
1
6
1
7
1
8
9
10
11
12
13
14
15
Total N
7
2
3
4
5
Total N
11-Pit shape'
1
I-Pit depth'
Components
2
14
3
4
3
1
1
1
8
5
14
3
9
3
15
3
9
1
2
15
8
1
1
2
2
1
1
2
2
4
8
4
4
8
Age interval
40-49
50-59
1
7
1
1
2
1
1
4
2
7
1
1
7
2
4
60-69
TABLE 4. Frequency distribution ofcomponents by age intervals
2
1
4
1
1
4
5
5
5
3
1
4
70-79
1
1
80-89
3
2
4
7
12
9
10
8
6
7
5
4
4
81
5
25
20
16
16
82
28
22
15
84
15
4
9
29
31
9
4
82
Total
N
METAMORPHOSIS AT THE STERNAL RIB END
component. Further comparison indicated
that the rib can provide a n age estimation
for individuals up to the mean age of 58
(component 111)through 62 (component 11)to
65 (component I). The oldest specimen analyzed in the McKern and Stewart study was
only 50 years old, compared with 85 years in
our sample. This maximum age difference
might partially account for the large standard deviation observed in this study.
Critical factors one should consider when
estimating age from the skeleton are interobserver error, human variability, health and
disease status, and occupation. Our research
indicated that the individual variation increased after the third decade. This could
result in greater difficulty in assessment of
the older ages. A similar increase in variation was also seen in the pubic symphysis.
Relative experience of the observer can also
affect estimation (Suchey, 1979). Suchey
found that errors in estimating age were inversely correlated with the experience of the
observer. A final problem is the durability of
the rib through time against environmental
factors. These effects would be most severe
on individuals in stages 4 and 5 owing to the
brittleness and fragility of the bone.
It has been suggested that both biomechanical and physiologic factors, such as stresses
produced during respiration and chest expansion, combine to create the transformations observed a t the costochondral junction
(King, 1939; Semine and Damon, 1975).
These effects would probably not be noticeable until rib growth is complete. It was felt
that this occurs a t age 17 since we observed
the first transition in sternal end morphology (from a flat to a cup-shaped extremity) at
this time. This is compatible with the histologic findings of Sedlin et al. (1963) that maturity in the rib is complete prior to age 20.
Ortner and Putschar (1981)have pointed out
that cartilage is more resistant to the effects
of intermittent and pulsating pressure than
bone; therefore, cessation of growth could
render the sternal extremity of the rib susceptible to reshaping around the costal cartilage with which it articulates.
Histologically, the most important factor
underlying the observed changes is the continuous periosteal deposition of new bone
(Sedlin et al., 1963; Ortner and Putschar,
1981), possibly accompanied by periochondral ossification (King, 1939). Thus, the
“deepening” of the pit seen with increasing
age is actually a build-up of periosteally pro-
155
duced walls of bone surrounding the sternal
extremity of the rib and extending over the
costal cartilage.
Another factor, endosteal resorption, must
also be considered. Following ossification of
the growth cartilage, the sternal extremity
of the rib has no active growth zone. However, endosteal resorption continues at a n
even greater rate than periosteal deposition,
thinning, and in some cases eventually eroding through the floor of the junction.
Although the metamorphoses described are
assumed to occur as manifestations of normal aging, there are several factors known
to affect the remodeling process which may
alter the aging pattern of the rib and cartilage (Murray, 1936; Lacroix, 1951; Bourne,
1956; Frost, 1963; Hall, 1978; Raisz and
Kream, 1983a,b).These factors include strenuous physical activity and heavy labor, endocrine disorders, chronic lung disease, drug
use, sex differences, diet, and intercostal variations (Rist et al., 1928; Riebel, 1929; King,
1939; Heudtlass and Garre, 1940; Fischer,
1955; Lichtenstein, 1975; Semine and Damon, 1975).
Among these factors there are two important issues particularly pertinent to this
study. The first involves intercostal variation
and positive identification of the fourth rib.
Semine and Damon (1975) emphasized that
the first rib changes with age a t a much
faster rate than the lower ones. In observing
radiographs provided by McCormick and
Stewart (1983) we saw gradual increase in
mineralization from the second rib. This suggests that a rib being identified as the third
or fifth may not significantly differ in morphology from that of the fourth rib and may
provide equally reliable results. Furthermore, side differences may play a role, however, McCormick and Stewart (1983) felt that
this was not a factor. There has been no serious attempt made to assess age-related differences between adjacent ribs, along with
any possible variation between the right and
left sides.
The second important factor is the difference between sexes noted in earlier radiographic studies (Falconer, 1938; Horner, 1949;
Fischer, 1955; Elkeles, 1966; Sanders, 1966;
Navani et al., 1974; McCormick and Stewart,
1983). Differences in hormonal production
probably account for this variation in the
aging pattern of the rib (King, 1939; Horner,
1949; Sanders, 1966; Semine and Damon,
1975). With this in mind, the next phase of
156
M.Y. I SCAN, S.R. LOTH. AND R.K. WRIGHT
the authors’ investigation is under way to
develop a n age-determination standard for
females.
ACKNOWLEDGMENTS
The authors thank Cargil Hinzey, Dean
Reynolds, and Eric Thompson for collecting
the specimens. We are especially grateful to
George Covaleski, Steve Corey, and Robert
Hinman also of the Broward County Medical
Examiner’s Office for their helpfulness in
providing us with accurate records of the
specimens. Karen I. Derrick was very helpful
a t the beginning of the project. We wish to
thank Carolyn D. Majd for her kind assistance in typing this manuscript. The authors
also thank the reviewers for their constructive criticism. This investigation was supported by Florida Atlantic University
Sponsored Research Grant No. 121210016
awarded to M.Y. Iqcan.
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Acsadi, G, and Nemeskeri, J (1970) History of Human
Life Span and Mortality. Budapest: Akademiai Kiado.
Bourne, GH (ed)(1956)The Biochemistry and Physiology
of Bone. New York: Academic Press.
Eckert, WG, and Noguchi, ‘IT (1974) The Bibliography
of References on Forensic Anthropology. Wichita, KS:
Inform.
Elkeles, A (1966): Sex differences in the calcification of
the costal cartilages. Am. Geriatr. J. 14r456-462.
Epker, BN, Kelin, M, and Frost, HM (1965) Magnitude
and location of cortical bone loss in human rib with
aging. Clin. Orthop. 4lt198-203.
Falconer, B (1938) Calcification of hyaline cartilage in
man. Arch. Pathol. 26t942-955.
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