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a Department of Family Medicine, Faculty for Health Sciences, Soroka Hospital, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Liubov Ben-Noun, P.O.B 572 Kiryat- Gat 82104, Israel E-mail: L-bennun{at}zahav.net.il.
Decision Editor: John E. Morley, MB, BCh
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Abstract |
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 Top Abstract Disease of Bones as...SummaryReferences |
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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, hyperparathyroidism, 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.
PATIENTS have suffered from pain in their bones, which may be associated with various diseases, for thousand of years. Who suffered from bone pains in Biblical times? What were the characteristics of the disease of the bones? What was the most likely diagnosis? This article aims to answer these questions by evaluating a disease of the bones as described in the Bible.
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Disease of Bones as Described in the Bible |
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TopAbstractDisease of Bones as...SummaryReferences |
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What does the phrase "my bones wasted away" mean? The 1990 Consensus Development Panel defined osteoporosis as a "disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk" (1). Because King David's bones were "wasted away," they became very weak; that is, the bone mass decreased. The decreased bone mass indicates that King David was suffering from osteoporosis. Contemporary medicine measures reduced bone mass by various techniques including conventional radiographs, computerized tomography, single or dual photon absorption densitometry, radiographic measurements of cortical width (radiogrammetry), resonance frequency of the ulna, total body neutron activation analysis, and x-ray microdensitometry (2). Because there is no word in the Biblical text about any of the methods listed above, one can speculate that no methods of evaluating osteoporosis were in use at that time. Nevertheless, the Biblical sentences quoted above indicate very convincingly that King David suffered from osteoporosis.
There are various diseases that can be associated with osteoporosis. What was the disease that affected King David?
Involutional or age-dependent senile osteoporosis occurs in men aged 70 or older and is characterized by trabecular and cortical bone loss leading to hip, vertebral, proximal humerus, proximal tibia, and pelvis fractures (3). It can be assumed that senile osteoporosis may have affected King David's bones. However, this does not entirely explain what kind of disease "consumed" his bones.
Cushing's syndrome refers to a metabolic disorder that results from high levels of glucocorticoids. Osteoporosis related to glucocorticoids may be so severe that collapse of vertebral bodies and pathological fractures of other bones may occur (4). Did Cushing's syndrome affect King David's bones? In the absence of truncal obesity, hypertension, hirsutism, plethoric face, purplish abdominal striae, edema, and glucose intolerance (4), this disease is very unlikely.
Did the king suffer from thyrotoxicosis? In thyrotoxicosis, demineralization of bones may occur, considerably more in axial than in appendicular bone (5). This diagnosis as a cause of osteoporosis should be ruled out in all patients who have bone demineralization (6). In the absence of nervousness, emotional lability, tremors, hyperhydrosis, heat intolerance, weight loss, palpitations, eye symptoms (such as lid lag or exophthalmos), a wide pulse pressure, sinus tachycardia, atrial arrhythmias (especially atrial fibrillation), systolic murmurs, cardiac enlargement, heart failure, and data on the level of thyroid stimulating hormone in serum, this disease seems very unlikely.
It has been reported that acromegaly may be associated with osteoporosis (7). Did King David suffer from this disease? In the absence of coarse facial features as the result of overgrowth of frontal, malar, and nasal bones, enlarged mandible, separated teeth, overgrowth of soft tissue producing widening of the nose and protrusion of the lips, enlarged hands and feet, thickened skin, enlarged sebaceous glands, and other clues that suggest this disease (e.g., carpal tunnel syndrome, diabetes mellitus, headache [sellar enlargement], and visual field defects) (8), this diagnosis seems very unlikely. It would also be ironic if David, who as a youth had slain the pituitary giant Goliath (9), was visited by the same disorder in his old age.
Hypogonadism may be associated with osteoporosis (3)(7). In the absence of hypospadias, cryptorchism in childhood, delayed puberty, gradual loss of male secondary sex characteristics and libido, impotence, and signs or symptoms of a disease that can produce hypogonadism (e.g., severe headache, indicating intracranial tumor) (8), this diagnosis may be unlikely. However, recent longitudinal studies have demonstrated that the majority of older men develop hypogonadism and that this can be reversed by testosterone replacement (10)(11)(12).
Primary hyperparathyroidism is a generalized disorder of calcium, phosphate, and bone metabolism that results from an increased secretion of parathyroid hormone (PTH). The excessive concentration of PTH usually leads to hypercalcemia and hypophosphatemia. Symptoms are usually associated with the degree of hypercalcemia; however, the patient may be asymptomatic. In advanced cases, manifestations of hypercalcemia include: central nervous system—lassitude, fatigability, poor memory, depression, and obtundation; ophthalmic—band keratopathy; cardiovascular—hypertension; digestive—anorexia, vomiting, constipation, ulcers, and pancreatitis; genitourinary—renal stones, decreased urine-concentrating capacity, and renal insufficiency; muscular—weakness; skeletal—osteoporosis, fractures, bone pain, brown tumors, and bone cysts; and joints—pseudogout (13).
Did King David suffer from hyperparathyroidism? It can be speculated that he may have suffered from this disease, which leads to osteoporosis, subsequent fractures, and severe bone pain. Did he suffer from asymptomatic renal stones, renal failure, or other asymptomatic manifestations of this disease? There are insufficient data to answer these questions. If this diagnosis is accepted, however, there is still no explanation for the disease that "consumed" King David's bones.
Paget's disease is a relatively common disorder, resulting from a primary overactivity of osteoclasts, which leads to excessive resorption of bone and the formation of disorganized, structurally defective bone. Commonly affected areas include the skull, spine, pelvis, femur, and tibia. The usual presenting symptoms are deformity and pain, the latter probably arising from periosteal stretching, microfractures, degenerative joint disease, or direct neural compression. The skull may become enlarged, and bowing of the femur and tibia are frequently seen. Increased warmth and sweating of the skin overlying the affected bones are common. In addition, a high-output cardiac failure may develop (14).
Was this disease responsible for King David's bone pain? In the absence of the deformity of bones, bowing of the femur or tibia, enlargement of the skull, or warmth and sweating skin over the affected bones, this diagnosis seems very unlikely.
Persons with a lifelong low intake of dairy products because of lactase deficiency have an increased incidence of osteoporosis (15). In the absence of abdominal pain, bloating, and diarrhea after lactose ingestion (16), this diagnosis seems very unlikely.
Biliary cirrhosis results from injury to or obstruction of either the intrahepatic or extrahepatic biliary system. It is associated with impaired biliary excretion, destruction of hepatic parenchyma, and progressive fibrosis (17). Liver cirrhosis at an advanced stage can lead to osteoporosis due to diminished vitamin D absorption, whereas deficiency of vitamin K contributes to bone fragility (17)(18). In the absence of pruritus, jaundice, hyperpigmentation of the exposed skin areas, xanthelasmas and tendinous and plantar xanthomas, hepatomegaly, splenomegaly, clubbing of the fingers, steatorrhea, easy bruising related to the malabsorption of vitamin K, night blindness due to vitamin A deficiency, and dermatitis due to vitamin E and/or essential fatty acid deficiency (2)(17), this diagnosis is very unlikely.
The prevalence of malnutrition, particularly undernutrition, increases with age (18). Deficiencies in micronutrients such as calcium and vitamin D can accelerate age-dependent bone loss (3), and a deficiency in vitamin K can accelerate bone fracture. A deficiency in macronutrient (protein) leads to lower femoral neck mineral density (18). Several factors can cause weight loss and lead to a state of malnutrition in elderly persons. Most of them act by reducing spontaneous food intake, although malabsorption and increased metabolism can also be implicated in some situations (19). Reduction in food intake occurs physiologically with aging (20), and this can be aggravated by various physical and mental disorders, poor appetite due to consumption of drugs, loss of taste and smell, inadequate access to foods due to poverty or to impairment of cognitive or physical functions, and chronic alcohol abuse (19)(21).
Did King David suffer from malnutrition or undernutrition? It is possible that for some reason the intake of food was reduced. However, it seems very unlikely that osteoporosis and possible subsequent fractures developed solely as a result of reduced food intake. Thus, it seems very unlikely that malnutrition or undernutrition per se were the cause of the king's bone disease.
Chronic obstructive lung disease has been found to be associated with osteoporosis (7). In the absence of a history of cough and sputum production (sometimes with wheezing) over many years, dyspnea, and signs of right ventricular failure (22), this diagnosis seems very unlikely.
Rheumatoid arthritis (RA) is a chronic multisystemic disease of unknown cause characterized by persistent inflammatory synovitis, usually involving wrists, metacarpophalangeal joints, knees, and feet in a symmetric distribution. A prodrome of fatigue, weakness, joint stiffness, arthralgias, and myalgias may precede the joint swelling. Constitutional manifestations include malaise, anorexia, low-grade fever, and an elevated sedimentation rate (23). Juxta-articular osteoporosis develops in early stages of RA; later, bony erosion appears at the joint margins with the destruction of subchondral bone, and diffuse osteoporosis develops at an advanced stage (24). In the absence of joint involvement accompanied by constitutional symptoms, this diagnosis is very unlikely in King David.
Malignancies of various types, particularly multiple myeloma, lymphoma, leukemia, systemic mastocytosis, and carcinomatosis, may result in diffuse loss of bone and subsequent fractures leading to severe bone pain (13). Because the king's bones were "wasted away" and "consumed," it is very likely that he suffered from one type of the malignant diseases listed above. The disease was severe enough to cause the king "anguished roaring all day long." What type of malignancy? There are insufficient data to answer this question.
This article and others on biblical affections (25)(26)(27) show that the roots of contemporary gerontology go back to biblical times. We have not included any commentaries but referred to the words of the Bible just as written.
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Received June 11, 2001
Accepted July 9, 2001
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This article has been cited by other articles:
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  L. Ben-Noun Mental Disorder that Afflicted King David the Great History of Psychiatry, December 1, 2004; 15(4): 467 - 476. [Abstract] [PDF]
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 J. E. Morley Editorial: Hot Topics in Geriatrics J. Gerontol. A Biol. Sci. Med. Sci., January 1, 2003; 58(1): M30 - 36. [Full Text] [PDF]
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L. Ben-Noun Was the Biblical King David Affected by Hypothermia? J. Gerontol. A Biol. Sci. Med. Sci., June 1, 2002; 57(6): M364 - 367. [Abstract] [Full Text]
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