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What Was the Disease of the Bones That Affected King David?

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What Was the Disease of the Bones That Affected King David? SPECIAL ARTICLE Journal of Gerontology: MEDICAL SCIENCES Copyright 2002 by The Gerontological Society of America 2002, Vol. 57A, No. 3, M152–M154 What Was the Disease of the Bones That Affected King David? Liubov (Louba) Ben-Noun Department of Family Medicine, Faculty for Health Sciences, Soroka Hospital, Ben-Gurion University of the Negev, Downloaded from https://academic.oup.com/biomedgerontology/article/57/3/M152/550372 by guest on 28 September 2021 Beer-Sheva, Israel. Background. Elderly people have suffered from pain in their bones, which may be associated with various diseases, for thousands of years. Methods. This report analyzes the disease that affected the Biblical King David, the second and greatest of Israel’s Kings, who ruled the country 3000 years ago. Results. The sentences “My strength failed. .and my bones are consumed,” and “My bones wasted away through my anguished roaring all day long” indicate that King David suffered from osteoporosis, which affected his bones. Among the various diseases that may be associated with osteoporosis, the most likely are senile osteoporosis, hyperparathyroid- ism, or malignant disease. Among these diseases, the diagnosis of malignancy is the most acceptable. Conclusion. This report demonstrates that the roots of contemporary modern gerontology can be traced to Biblical times. ATIENTS have suffered from pain in their bones, which no word in the Biblical text about any of the methods listed P may be associated with various diseases, for thousand above, one can speculate that no methods of evaluating os- of years. Who suffered from bone pains in Biblical times? teoporosis were in use at that time. Nevertheless, the Bibli- What were the characteristics of the disease of the bones? cal sentences quoted above indicate very convincingly that What was the most likely diagnosis? This article aims to an- King David suffered from osteoporosis. swer these questions by evaluating a disease of the bones as There are various diseases that can be associated with os- described in the Bible. teoporosis. What was the disease that affected King David? Involutional or age-dependent senile osteoporosis occurs DISEASE OF BONES AS DESCRIBED IN THE BIBLE in men aged 70 or older and is characterized by trabecular King David, the second and greatest of Israel’s Kings and cortical bone loss leading to hip, vertebral, proximal hu- who ruled that country 3000 years ago, suffered from a dis- merus, proximal tibia, and pelvis fractures (3). It can be as- ease of the bones: “My strength failed. .and my bones are sumed that senile osteoporosis may have affected King consumed” (Psalm XXXI:11); “My bones wasted away David’s bones. However, this does not entirely explain what through my anguished roaring all day long” (Psalm XXXII: kind of disease “consumed” his bones. 3). The first sentence indicates that the king’s bones were Cushing’s syndrome refers to a metabolic disorder that re- used up, his strength was decreased, and he had become sults from high levels of glucocorticoids. Osteoporosis re- very weak. In the second sentence, the king’s bones had lated to glucocorticoids may be so severe that collapse of ver- reached a stage where they were extremely thin and weak, tebral bodies and pathological fractures of other bones may causing him severe pain. occur (4). Did Cushing’s syndrome affect King David’s What does the phrase “my bones wasted away” mean? bones? In the absence of truncal obesity, hypertension, hirsut- The 1990 Consensus Development Panel defined os- ism, plethoric face, purplish abdominal striae, edema, and teoporosis as a “disease characterized by low bone mass and glucose intolerance (4), this disease is very unlikely. microarchitectural deterioration of bone tissue, leading to Did the king suffer from thyrotoxicosis? In thyrotoxico- enhanced bone fragility and a consequent increase in frac- sis, demineralization of bones may occur, considerably ture risk” (1). Because King David’s bones were “wasted more in axial than in appendicular bone (5). This diagnosis away,” they became very weak; that is, the bone mass de- as a cause of osteoporosis should be ruled out in all patients creased. The decreased bone mass indicates that King David who have bone demineralization (6). In the absence of ner- was suffering from osteoporosis. Contemporary medicine vousness, emotional lability, tremors, hyperhydrosis, heat measures reduced bone mass by various techniques includ- intolerance, weight loss, palpitations, eye symptoms (such ing conventional radiographs, computerized tomography, as lid lag or exophthalmos), a wide pulse pressure, sinus tachy- single or dual photon absorption densitometry, radiographic cardia, atrial arrhythmias (especially atrial fibrillation), sys- measurements of cortical width (radiogrammetry), reso- tolic murmurs, cardiac enlargement, heart failure, and data nance frequency of the ulna, total body neutron activation on the level of thyroid stimulating hormone in serum, this analysis, and x-ray microdensitometry (2). Because there is disease seems very unlikely. M152 KING DAVID’S BONE DISEASE M153 It has been reported that acromegaly may be associated Was this disease responsible for King David’s bone pain? with osteoporosis (7). Did King David suffer from this dis- In the absence of the deformity of bones, bowing of the fe- ease? In the absence of coarse facial features as the result of mur or tibia, enlargement of the skull, or warmth and sweat- overgrowth of frontal, malar, and nasal bones, enlarged ing skin over the affected bones, this diagnosis seems very mandible, separated teeth, overgrowth of soft tissue produc- unlikely. ing widening of the nose and protrusion of the lips, enlarged Persons with a lifelong low intake of dairy products be- hands and feet, thickened skin, enlarged sebaceous glands, cause of lactase deficiency have an increased incidence of and other clues that suggest this disease (e.g., carpal tunnel osteoporosis (15). In the absence of abdominal pain, bloat- syndrome, diabetes mellitus, headache [sellar enlargement], ing, and diarrhea after lactose ingestion (16), this diagnosis and visual field defects) (8), this diagnosis seems very un- seems very unlikely. Downloaded from https://academic.oup.com/biomedgerontology/article/57/3/M152/550372 by guest on 28 September 2021 likely. It would also be ironic if David, who as a youth had Biliary cirrhosis results from injury to or obstruction of slain the pituitary giant Goliath (9), was visited by the same either the intrahepatic or extrahepatic biliary system. It is disorder in his old age. associated with impaired biliary excretion, destruction of Hypogonadism may be associated with osteoporosis hepatic parenchyma, and progressive fibrosis (17). Liver cir- (3,7). In the absence of hypospadias, cryptorchism in child- rhosis at an advanced stage can lead to osteoporosis due to hood, delayed puberty, gradual loss of male secondary sex diminished vitamin D absorption, whereas deficiency of vi- characteristics and libido, impotence, and signs or symp- tamin K contributes to bone fragility (17,18). In the absence toms of a disease that can produce hypogonadism (e.g., se- of pruritus, jaundice, hyperpigmentation of the exposed skin vere headache, indicating intracranial tumor) (8), this diag- areas, xanthelasmas and tendinous and plantar xanthomas, nosis may be unlikely. However, recent longitudinal studies hepatomegaly, splenomegaly, clubbing of the fingers, steat- have demonstrated that the majority of older men develop orrhea, easy bruising related to the malabsorption of vitamin hypogonadism and that this can be reversed by testosterone K, night blindness due to vitamin A deficiency, and derma- replacement (10–12). titis due to vitamin E and/or essential fatty acid deficiency Primary hyperparathyroidism is a generalized disorder of (2,17), this diagnosis is very unlikely. calcium, phosphate, and bone metabolism that results from The prevalence of malnutrition, particularly undernutri- an increased secretion of parathyroid hormone (PTH). The tion, increases with age (18). Deficiencies in micronutrients excessive concentration of PTH usually leads to hypercalce- such as calcium and vitamin D can accelerate age-depen- mia and hypophosphatemia. Symptoms are usually associ- dent bone loss (3), and a deficiency in vitamin K can accel- ated with the degree of hypercalcemia; however, the patient erate bone fracture. A deficiency in macronutrient (protein) may be asymptomatic. In advanced cases, manifestations of leads to lower femoral neck mineral density (18). Several hypercalcemia include: central nervous system—lassitude, factors can cause weight loss and lead to a state of malnutri- fatigability, poor memory, depression, and obtundation; tion in elderly persons. Most of them act by reducing spon- ophthalmic—band keratopathy; cardiovascular—hyperten- taneous food intake, although malabsorption and increased sion; digestive—anorexia, vomiting, constipation, ulcers, metabolism can also be implicated in some situations (19). and pancreatitis; genitourinary—renal stones, decreased Reduction in food intake occurs physiologically with aging urine-concentrating capacity, and renal insufficiency; mus- (20), and this can be aggravated by various physical and cular—weakness; skeletal—osteoporosis, fractures, bone mental disorders, poor appetite due to consumption of pain, brown tumors, and bone cysts; and joints—pseudo- drugs, loss of taste and smell, inadequate access to foods gout (13). due to poverty or to impairment
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