Intergenerational health impacts from the Holocaust – study

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Starvation in early life can cause poor bone health and metabolic aberrations in bone minerals, leading to abnormal bone development. Since Holocaust survivors were exposed to starvation and malnutrition before and during World War II, a team of Albanian researchers has conducted a meta-analysis to present the current state of knowledge on the osteoporosis risk in the dwindling number of survivors and their descendants.

Dr. Malvina Hoxha of the chemical-toxicological and pharmacological evaluation of drugs department at the Faculty of Pharmacy in the Catholic University Our Lady of Good Counsel in Tirana and Dr. Visar Malaj of the University of Tirana’s economics department has just published their findings in the Rambam Maimonides Medical Journal issued by the Rambam Health Care Campus in Haifa under the title, “The Current State of Knowledge on Osteoporosis in Holocaust Survivors and Their Descendants.”

The team included ten studies in its review. Seven of the studies were case-control ones, while the rest were self-reported, including one that was a longitudinal study that followed patients for many years. Despite the limited number of people studied and the small number of pieces of published research, the report said: “The data showed a potential increased risk of osteoporosis in Holocaust survivors and especially in their descendants.”

During the Nazi Holocaust between 1933 to 1945, almost two out of three Jews living in countries under the control or influence of Germany were executed. A small proportion of survivors were former prisoners of concentration camps, ghettos, and killing centers. In addition, hundreds of thousands of Jews survived the Holocaust by escaping Nazi-occupied territories. Most were exposed to significant nutritional deprivation.

The type of nutritional deprivation differed, depending on whether survivors had lived in a work camp, ghetto, or extermination camp, had been in hiding, or a combination thereof. Each type of deprivation presented its own dangers, the researchers wrote.

HUNGARIAN JEWS on the ‘selection’ ramp at Auschwitz II-Birkenau in occupied Poland, spring 1944. This photo is from the ‘Auschwitz Album,’ the only surviving visual evidence of the mass murder process at Auschwitz-Birkenau. (credit: YAD VASHEM/WIKIMEDIA COMMONS)
For example, some survivors were fed only with corn. Others were given grass peas, which, if consumed in high quantities, caused severe motor neuron disease. Starvation among infants can lead to demineralization of the bones in both boys and girls. Low vitamin D and calcium levels and nutritional deprivation are predictors of low bone density, the report said.

The term “hunger disease,” which refers to the effect of starvation, was diagnosed by 28 Jewish physicians among the small number of Jewish survivors of the Warsaw Ghetto. Autopsies of individuals who died of starvation in the ghetto revealed porous bones and decalcification. Irregular heartbeat, low blood pressure, depression, insomnia, irritability, excessive fatigue, muscle pain, hernias, and back trouble were some of the symptoms of famine disease.

Nutritional deprivation in pregnant women

“Nutritional deprivation in pregnant women, including calcium and vitamin D, could also lead to premature osteoporosis in adults, premature metabolic syndrome, reduced peak-bone mass, and more,” the report said.

“Pregnant women need a sufficient supply of vitamins and minerals, nutrients found in milk, meat, and other proteins, but these basic requirements were not met, and the prolonged nutritional deprivation of the Jewish population in concentration camps and ghettos, especially in pregnant women, led to abnormal fetal skeletal development and osteoporosis.”

The risk of falling and having a hip fracture and the prevalence of osteoporosis has been shown to be increased among men and women who lived under the Nazi regime or in a Nazi-occupied country.

While mental health conditions such as post-traumatic stress disorder (PTSD) and the increased incidence of cancer among survivors have been widely studied, the prevalence of osteoporosis has not.

The meta-analysis showed a higher prevalence of osteoporosis and hip fractures among Holocaust survivors and their offspring. Knowledge of the trans-generational inheritance of osteoporosis in the descendants of Holocaust survivors should increase the awareness of primary-care health workers about the problem, the researchers concluded. 

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