Medical Examiner

Epstein’s Broken Hyoid Bone Doesn’t Tell Us Much

It’s still much, much more likely that he died by suicide than that he was murdered.

Guard booth and facade of the MCC, behind trees.
The Metropolitan Correctional Center in New York City on Saturday.
David Dee Delgado/Getty Images

On Wednesday morning, the Washington Post reported that two people with knowledge of Jeffrey Epstein’s autopsy said that it showed his hyoid bone had broken when he reportedly died by suicide in prison on Saturday morning. The story quickly gained steam, including on Slate, because multiple experts noted that this is more common in homicide victims than in suicide victims. But it is worth stating plainly: A broken hyoid bone doesn’t really suggest he was murdered. In fact, it adds almost no useful information at all. Thinking it does underscores how bad we all are at understanding basic math.

Yes, the hyoid—the U-shaped bone located at the top and front of the neck—is more likely to be broken when a person has been strangled than if they were hanged. But the hyoid is also broken in hangings—possibly infrequently, and possibly often. There’s no agreement in the forensics community on exactly how frequently, but it is known to occur and is not considered remarkable.

Here’s some basic math. Each year, around 16,000 men are murdered in the United States. Of those, approximately 385 are strangled (2.4 percent). Meanwhile, around 35,000 men die by suicide, 8,000 (23 percent) of those by hanging. This means that if a medical examiner encounters a random dead body (but no other information), it is over 20 times more likely that the man died by hanging than by strangulation. Even after the discovery of a broken hyoid bone, the overall odds would still heavily favor hanging, even though the rate of hyoid bone fracture is indeed somewhat higher in strangulation, because broken hyoid bones aren’t 20 times more likely to be broken during strangulation than hanging. Not even close.

If a broken hyoid bone was rarely or never associated with death by hanging, then there might be something here. But in the study cited by the Washington Post itself, 25 percent of patients who died by suicidal hanging had broken hyoids. That’s not a small number. Also, the average age of patients with this finding was 61 (Epstein was 66), much older than those in the study without broken hyoids.

Further, when making medical diagnoses (and cause of death is a medical diagnosis), we don’t follow likelihoods in isolation. We try to look at context. Take dilated cardiomyopathy, a common heart problem in which the heart is enlarged and loses efficiency. The most likely reason to develop this condition in America is preexisting disease of the coronary arteries. But if you just flew in from Honduras and have body aches, shortness of breath, and some leg swelling, Chagas disease becomes a drastically more likely cause of dilated cardiomyopathy. The parasite that causes Chagas disease is not even found in the U.S., but, given the circumstances, given the context, it is more likely to be correct in this specific case.

If investigators discovered a dead body slumped on the ground in a private home with no obvious cause of death, the situation would be rather different. No noose? No rope marks around the neck? No suicide note? No history of depression or recent traumatic life changes? Sure, in that case discovering a broken hyoid might correctly move detectives toward a murder investigation. But the known facts of Epstein’s death, the known circumstances that he had indeed recently lost everything and stood little chance of redemption, matter greatly. Finding a broken hyoid bone on the autopsy is hardly a Columbo moment. Given the statistics, and given the context, it remains far more likely that Epstein broke his hyoid while killing himself than that it was broken as he was murdered.

The opinions expressed in this article are solely those of the author and do not reflect the views and opinions of Brigham and Women’s Hospital.