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Updated: Aug 2, 2025
Scanning Skeletal Remains for Bone Mineral Density in Forensic Contexts
Published on: January 29, 2018
Low bone mineral density is associated with fatty liver disease and respiratory illness in a pediatric mortality
Ethan C Hill1, Lexi O'Donnell2
1Division of Physical Therapy, Department of Orthopaedics and Rehabilitation, University of New Mexico School of Medicine, MSC09 5230, 1 University of New Mexico, Albuquerque, NM, 87131, USA. echill@salud.unm.edu.
Insights
Children with fatty liver disease show lower bone density. This finding is significant for clinicians managing pediatric non-alcoholic fatty liver disease and its impact on bone health.
Area of Science:
- Pediatric Endocrinology
- Bone Metabolism
- Hepatology
Background:
- Chronic illnesses negatively impact bone modeling and remodeling, crucial during childhood and adolescence for achieving peak bone mass.
- Non-alcoholic fatty liver disease (NAFLD) prevalence has risen in children, necessitating an understanding of its skeletal effects.
Purpose of the Study:
- To investigate the relationship between chronic illnesses, including fatty liver disease, and low bone mineral density (BMD) in a pediatric mortality sample.
- To determine if low BMD correlates with decelerated linear growth, assessed via growth stunting and Harris lines.
Main Methods:
- Trabecular bone mineral density (BMD) was estimated using Hounsfield units (HU) from postmortem CT scans of the lumbar vertebra and femoral neck.
- Linear regression analysis examined associations between z-standardized HU and factors such as age, sex, medical conditions, Harris lines, and growth stunting.
Main Results:
- Individuals with fatty liver disease and respiratory illness exhibited significantly lower lumbar HU.
- Femoral HU was significantly lower in individuals presenting with Harris lines.
Conclusions:
- Low BMD in fatty liver disease and respiratory illness may stem from multifactorial causes including vitamin D deficiency, inflammation, and inactivity.
- Early clinical awareness can prompt nutritional and behavioral interventions to protect bone health in affected children.
- Harris lines indicate temporary growth cessation; low BMD in these cases might reflect lagging bone mineralization relative to rapid linear growth.
Abstract:
This study finds that fatty liver disease is associated with low bone density in a pediatric mortality sample. Since non-alcoholic fatty liver disease has increased in prevalence over the past few decades among children, a better understanding of the disease's impacts on bone health is of significance to clinicians.
Purpose:
Chronic illness leads to decreased bone modeling and remodeling. This can be especially problematic during childhood and adolescence, since the majority of an individual's peak bone mass is achieved by the age of 20. In this study, we examine relationships between chronic illness and low bone mineral density (BMD) in a pediatric mortality sample (aged 0.5 to 20.9 years) from New Mexico. We also test whether low BMD is related to decelerated linear growth by examining its relationship to growth stunting and arrest (Harris lines).
Methods:
Hounsfield units (HU), a proxy for trabecular BMD, were obtained at the fourth lumbar vertebra and the femoral neck from postmortem CT scans. Linear regression was used to examine associations between z-standardized HU and age, sex, medical conditions, Harris lines, and growth stunting.
Results:
We find that lumbar HU is significantly lower for individuals with fatty liver disease and respiratory illness; femoral HU is significantly lower in individuals with Harris lines.
Conclusion:
The mechanisms of low BMD in individuals with fatty liver disease and respiratory illness are likely multifactorial and involve vitamin D deficiency (malnutrition, malabsorption), systemic inflammation, and sedentary lifestyles. However, better awareness of this relationship can provide clinicians with the ability to introduce nutritional and behavioral interventions early to mitigate deleterious effects on bone. Harris lines, on the other hand, mark temporary growth cessation due to physiological stress followed by a rapid resumption of growth. Low BMD in these individuals may be due to bone mineralization lagging behind relatively rapid linear growth.
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