Cribra orbitalia and cribra cranii in perspective: Rethinking etiology through life course and ONE Paleopathology approaches

OBJECTIVE: Porous cranial lesions (PCLs)-cribra orbitalia and cribra cranii-are frequently observed in human skeletal remains. This article aims to review how PCLs have been interpreted over time and to challenge oversimplistic associations while proposing a more comprehensive and integrative framework for their analysis in line with recent bioarcheological perspectives. METHODS: A critical literature review of theoretical and empirical studies on PCLs was conducted. RESULTS: This analysis highlights the limitations of interpreting PCLs either as "nonspecific stress indicators" or a marker of anemia, without differential diagnosis. Recent research has expanded the range of potential etiologies, emphasizing the need to consider environmental and living conditions. SIGNIFICANCE: It is proposed that PCLs should be interpreted through a life course perspective, situating individuals and/or groups within their sociocultural and environmental contexts, in line with the ONE Paleopathology approach. Such perspectives not only refine diagnostic accuracy but also deepen our understanding of the complex interplay between biology, environment, and culture in shaping health and disease of past populations. LIMITATIONS: The discussion is primarily conceptual and reliant on published data; empirical validation through new imaging and biomolecular studies is necessary. The limited availability of cross-species and longitudinal data constrains definitive conclusions. SUGGESTIONS FOR FURTHER RESEARCH: Future studies should apply CT and micro-CT analyses to both human and non-human, explore longitudinal clinical data, and integrate paleogenetic and environmental information to clarify PCLs etiology.