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

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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.

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Fig. 1

Adapted from Zemel et al. [101]

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Authors and Affiliations

  1. Division of Endocrinology and Diabetes, Monroe Carell, Jr Children’s Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, TN, 37232, USA

    Jennifer C. Kelley

  2. Department of Endocrinology and Diabetes, Birmingham Children’s Hospital, Birmingham, UK

    Nicola Crabtree

  3. Division of Gastroenterology, Hepatology and Nutrition, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Room 1560, Philadelphia, PA, 19104, USA

    Babette S. Zemel

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  1. Jennifer C. Kelley
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  2. Nicola Crabtree
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  3. Babette S. Zemel
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Correspondence to Babette S. Zemel.

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Jennifer Kelley, Nicola Crabtree, and Babette Zemel have declared no conflict of interest.

Human and Animal Rights and Informed consent

The findings reported in this manuscript are based on previously published work. No original data was collected. All images have been deidentified for protection of privacy

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Kelley, J.C., Crabtree, N. & Zemel, B.S. Bone Density in the Obese Child: Clinical Considerations and Diagnostic Challenges. Calcif Tissue Int 100, 514–527 (2017). https://doi.org/10.1007/s00223-016-0233-4

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  • DOI: https://doi.org/10.1007/s00223-016-0233-4

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