Bone Density in the Obese Child: Clinical Considerations and Diagnostic Challenges

Abstract

The prevalence of obesity in children has reached epidemic proportions. Concern about bone health in obese children, in part, derives from the potentially increased fracture risk associated with obesity. Additional risk factors that affect bone mineral accretion, may also contribute to obesity, such as low physical activity and nutritional factors. Consequences of obesity, such as inflammation, insulin resistance and non-alcoholic fatty liver disease, may also affect bone mineral acquisition, especially during the adolescent years when rapid increases in bone contribute to attaining peak bone mass. Further, numerous pediatric health conditions are associated with excess adiposity, altered body composition or endocrine disturbances that can affect bone accretion. Thus, there is a multitude of reasons for considering clinical assessment of bone health in an obese child. Multiple diagnostic challenges affect the measurement of bone density and its interpretation. These include greater precision error, difficulty in positioning, and the effects of increased lean and fat tissue on bone health outcomes. Future research is required to address these issues to improve bone health assessment in obese children.

Relative contributions of lean and fat mass to bone strength in young Hispanic and non-Hispanic girls

“…Many previous studies assessing the effect of soft tissue composition on the developing bones of children have relied on DXA, which has inherent limitations when it comes to assessing bone density in the growing skeleton and lacks an analysis of bone geometry and therefore estimates of bone resistance to fracture in children. [12]…”

“…BMC and areal bone mineral density (aBMD)). [12] However, bone strength, and consequently risk of fracture, is determined by both the material properties (i.e. mass and density) and the geometric properties of bone (i.e.…”

Evolutionary Perspectives on the Developing Skeleton and Implications for Lifelong Health

“…Adolescents with anorexia have low bone density and reduced strength compared to normal weight peers, and these effects can be long lasting (79,80). At the other end of the spectrum, children with obesity have greater bone mineral content and density and greater cortical thickness than non-obese children (81). However, they experience greater risk of fracture (82) and greater complications from fractures (83) than peers who are not obese.…”

Association Between Nonalcoholic Fatty Liver Disease and Reduced Bone Mineral Density in Children: A Meta‐Analysis

“…In particular, we believe that the lack of data on serum vitamin D 3 concentrations or vitamin D supplementation is one of the most important weaknesses of the included studies, given that low vitamin D 3 is a risk factor for osteomalacia and osteoporosis both in adults and in adolescents . Finally, it should also be remembered that some diagnostic challenges might affect BMD measurement and its interpretation in obese children (e.g., greater precision error, difficulty in positioning, and effects of increased lean and fat tissue on bone health outcomes) . Thus, future research is needed to address these issues for improving bone health assessment in obese children.…”

“…(36,38) Finally, it should also be remembered that some diagnostic challenges might affect BMD measurement and its interpretation in obese children (e.g., greater precision error, difficulty in positioning, and effects of increased lean and fat tissue on bone health outcomes). (39) Thus, future research is needed to address these issues for improving bone health assessment in obese children.…”