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Updated: Jul 29, 2025
Scanning Skeletal Remains for Bone Mineral Density in Forensic Contexts
Published on: January 29, 2018
Age-related trajectory of bone density in children with intestinal failure: A longitudinal retrospective cohort study
Farhana Ali1, Conrad R Cole1,2, Lindsey Hornung3
1Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Insights
Children with intestinal failure (IF) often have short stature, but bone mineral deficits are less common when adjusted for height. Bone density improved with age and reduced parenteral nutrition dependence.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Endocrinology
- Pediatric Bone Health
Background:
- Bone health in children with intestinal failure (IF) requires further investigation.
- Understanding bone mineral status trajectories in IF is crucial for management.
Purpose of the Study:
- To examine longitudinal bone mineral status in children with IF.
- To identify clinical factors influencing bone health trajectories in this population.
Main Methods:
- Retrospective review of 34 children with IF (diagnosed before age 3) with at least two DXA scans.
- Analysis of bone density z-scores, with and without height adjustment, and clinical data.
- Assessment of factors including parenteral nutrition, etiology of IF, and vitamin D status.
Main Results:
- Children with IF were shorter (mean height z-score -1.5).
- Height-adjusted bone density deficits were less prevalent (11% < -2.0) compared to unadjusted scores (25% < -2.0).
- Bone density z-scores improved with age and decreased parenteral nutrition, and were higher without feeding tube artifacts.
Conclusions:
- Short stature is common in children with IF.
- Height-adjusted bone density assessments provide a more accurate picture of bone health.
- Etiology of IF, prematurity, and vitamin D status did not correlate with bone density in this cohort.
Background:
Longitudinal changes in bone health in children with intestinal failure (IF) are unclear. We aimed to better understand the trajectory of bone mineral status over time in children with IF and identify clinical factors that influence the trajectory.
Methods:
Clinical records of patients attending the Intestinal Rehabilitation Center of Cincinnati Children's Hospital Medical Center between 2012 and 2021 were reviewed. Children diagnosed with IF before age 3 years with at least two lumbar spine dual-energy x-ray absorptiometry scans were included. We abstracted information on medical history, parenteral nutrition, bone density, and growth. We calculated bone density z scores with and without adjustment for height z scores.
Results:
Thirty-four children with IF met inclusion criteria. Children were shorter than average with a mean height z score of -1.5 ± 1.3. The mean bone density z score was -1.5 ± 1.3 with 25 of the cohort having a z score < -2.0. After height adjustment, the mean bone density z score was -0.42 ± 1.4 with 11% below -2.0. Most dual-energy x-ray absorptiometry scans (60%) had a feeding tube artifact. Bone density z scores increased slightly with age and lower parenteral nutrition dependency and were higher in scans without an artifact. Etiologies of IF, line infections, prematurity, and vitamin D status were not associated with height-adjusted bone density z scores.
Conclusion:
Children with IF were shorter than expected for age. Deficits in bone mineral status were less common when adjusting for short stature. Etiologies of IF, prematurity, and vitamin D deficiency were not associated with bone density.
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