Unlocking the potential of bone marrow in postmortem forensic toxicology: current evidence and future perspectives

Bone marrow (BM) has emerged as a valuable alternative matrix in postmortem toxicology, when conventional samples such as blood or soft tissues are unavailable, degraded or contaminated. BM, due to its protecting anatomical site within the medullary cavity, slows down decomposition, limits environmental and microbial interference and enables the preservation of xenobiotics over extended postmortem intervals. This review summarizes the updated literature on BM anatomy, sampling site, xenobiotic distribution and stability, as well as the influence of postmortem redistribution (PMR) and putrefaction for toxicological interpretation of the analytical results. Evidence indicates that drug distribution in BM is governed by tissue vascularity and analyte physicochemical properties, with lipophilic compounds often reaching higher concentrations in BM than in blood. Numerous studies demonstrate the long-term stability of drugs such as amphetamines, benzodiazepines, sedative-hypnotics and ethanol in BM, even in severely decomposed, burned, or skeletonized remains. While BM shows reduced susceptibility to PMR and putrefaction compared to blood and soft tissues, post-collection stability depends on proper storage conditions. Findings from human forensic cases assess the detectability of a wide range of illicit and therapeutic substances in BM, supporting its utility in reconstructing ante-mortem drug exposure when traditional matrices are compromised. Despite promising results, data remain limited, and further research is needed to refine interpretative frameworks and establish standardized protocols for BM sampling, analysis, and toxicological evaluation.