[2][3] This condition was widely accepted as a result of anemia, which is typically due to an iron deficient diet,[4] but several lines of evidence suggest that the accelerated loss and compensatory over-production of red blood cells seen in hemolytic and megaloblastic anemia are the most likely proximate causes of porotic hyperostosis.
[5] In anthropology, the presence of the condition has been considered evidence that a past population suffered chronic or episodic malnutrition.
A sub-discipline known as paleonutrition has focused on the presence of porotic hyperostosis, among other nutritional disorders.
A high incidence of the disease indicates the population adapted poorly to its environment or was under nutritional stress.
[4] From this perspective, porotic hyperostosis could be viewed as a biological attempt to adapt to the environment, rather than an indicator of malnutrition.