The Pamir plateau is one of the highest mountain systems in the world, presenting a highly challenging environment for human occupation. During the Soviet era, researchers discovered several stratified archaeological sites in the Pamir zone – including the Oshhona site, which yielded a large collection of lithic artefacts and personal ornaments made of bone. Pairing archaeozoological and biomolecular methods (Zooarchaeology by Mass Spectrometry) with use-wear analysis, we investigate the tradition of personal bone ornament production that emerged in the Pamir mountains during the Middle Holocene. Our analyses indicate that inhabitants of Oshhona site used a wide range of faunal remains to manufacture non-utilitarian items – including pendants, elongated beads, and engraved bone. Comparison of raw materials, manufacture technology, and style provide compelling evidence of cultural links between the Pamir and the middle highlands of the Tian Shan. Although available anthropological and genetic evidence is too scattered to assess the possibility of population movements, our results point to a shared techno-cultural tradition or common cultural adaptation in bone ornament production across these two regions, perhaps developing as a response to life at high altitudes in Central Asia during the Middle Holocene.