Division 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.
College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
Osteoporos Int. 2023 Jul;34(7):1231-1239. doi: 10.1007/s00198-023-06760-4. Epub 2023 Apr 21.
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.
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).
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.
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.
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.
慢性病导致骨形成和骨重建减少。这在儿童时期尤其成问题，因为个体的大部分峰值骨量是在 20 岁之前获得的。在这项研究中，我们检查了新墨西哥州儿科死亡率样本（年龄 0.5 至 20.9 岁）中慢性疾病与低骨密度（BMD）之间的关系。我们还通过检查其与生长迟缓的关系来测试低 BMD 是否与线性生长减速有关，即检查其与生长停滞和停止（Harris 线）的关系。
从死后 CT 扫描中获得第四腰椎和股骨颈的 Hounsfield 单位（HU），这是小梁 BMD 的替代物。线性回归用于检查 z 标准化 HU 与年龄、性别、医疗状况、Harris 线和生长迟缓之间的关系。
我们发现，患有脂肪肝和呼吸疾病的个体的腰椎 HU 明显较低；有 Harris 线的个体的股骨 HU 明显较低。
脂肪肝和呼吸疾病患者 BMD 降低的机制可能是多因素的，涉及维生素 D 缺乏（营养不良、吸收不良）、全身炎症和久坐不动的生活方式。然而，更好地了解这种关系可以使临床医生能够及早引入营养和行为干预措施，以减轻对骨骼的有害影响。另一方面，Harris 线标志着由于生理应激导致的暂时性生长停止，随后快速恢复生长。这些个体的低 BMD 可能是由于骨矿化滞后于相对快速的线性生长。
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