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Updated: Oct 21, 2025
Scanning Skeletal Remains for Bone Mineral Density in Forensic Contexts
Published on: January 29, 2018
Bone mineral density and fractures in institutionalised children with epilepsy and intellectual disability
J J L Berkvens1, S Mergler2,3, K Beerhorst4
1Department of Residential Care, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands.
Insights
Institutionalized children with epilepsy and intellectual disability (ID) frequently experience low bone mineral density (BMD) and fractures, even with vitamin D and calcium supplementation. This highlights a critical need for targeted bone health interventions in this vulnerable population.
Area of Science:
- Pediatric Endocrinology
- Neurology
- Bone Metabolism
Background:
- Long-term antiseizure drug (ASD) use is linked to reduced bone mineral density (BMD) and increased fracture risk.
- Limited research exists on bone health in institutionalized children with epilepsy on chronic ASDs.
- Intellectual disability (ID) in conjunction with epilepsy may present unique challenges to bone health management.
Purpose of the Study:
- To determine the prevalence of low BMD in institutionalized children with epilepsy and ID.
- To assess the incidence of fractures in this specific pediatric population.
- To evaluate bone health status in institutionalized children receiving chronic antiseizure medications.
Main Methods:
- Cross-sectional study involving 24 institutionalized children (ages 5-17) in the Netherlands.
- Dual-energy X-ray absorptiometry (DXA) of the lumbar spine and hip to assess BMD.
- Retrospective review of medical records for fracture history and measurement of serum calcium and 25-hydroxyvitamin D levels.
Main Results:
- 67% of children exhibited low BMD (Z-score ≤ -2.0), with 3 diagnosed with osteoporosis based on fracture history.
- 41.7% of children had a documented history of at least one fracture.
- Serum calcium and vitamin D levels were within normal ranges, despite supplementation.
Conclusions:
- A high prevalence of low BMD (67%) and fractures (42%) was observed in institutionalized children with epilepsy and ID.
- Current calcium and vitamin D supplementation protocols may be insufficient to prevent bone density loss in this population.
- Further research and tailored interventions are needed to address bone health concerns in institutionalized children with epilepsy and ID on chronic ASDs.
Background:
Long-term use of antiseizure drugs is associated with a low bone mineral density (BMD) and an increased fracture risk. The literature regarding institutionalised children on chronic antiseizure drugs is limited. Therefore, the aim of this cross-sectional study is to evaluate the prevalence of low BMD and the history of fractures in institutionalised children with epilepsy and intellectual disability (ID).
Methods:
A dual-energy X-ray absorptiometry of lumbar spine (L1-L4) and hip was performed in 24 children, residing in a long-stay care facility in the Netherlands. Additionally, serum concentrations of albumin, calcium and 25-hydroxyvitamin D were determined. Data on fractures were retrospectively extracted from the medical files.
Results:
Ages of the children (14 male and 10 female) ranged from 5 to 17 years with a mean age of 13.0 (±3.2). The criteria of the International Society for Clinical Densitometry (ISCD) were used for classification of bone mineral disorders. Eight (33.3%) children had a normal BMD (Z-score > - 2.0). Of the 16 children with a low BMD (Z-score ≤ - 2.0), three were diagnosed as osteoporotic, based on their fracture history. Ten children (41.7%) were reported to have at least one fracture in their medical history. Serum concentrations of albumin-corrected calcium (2.28-2.50 mmol/L) and (supplemented) vitamin D (16-137 nmol/L) were within the normal range.
Conclusions:
This study demonstrated that 67% of institutionalised children with epilepsy and ID had low BMD and 42% had a history of at least one fracture, despite supplementation of calcium and vitamin D in accordance with the Dutch guidelines.
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