Scanning Skeletal Remains for Bone Mineral Density in Forensic Contexts

Abstract

The purpose of this paper is to introduce a promising, novel method to aid in the assessment of bone quality in forensically relevant skeletal remains. BMD is an important component of bone's nutritional status and in skeletal remains of both juveniles and adults, and it can provide information about bone quality. For adults remains, it can provide information on pathological conditions or when bone insufficiency may have occurred. In juveniles, it provides a useful metric to elucidate cases of fatal starvation or neglect, which are generally difficult to identify. This paper provides a protocol for the anatomical orientation and analysis of skeletal remains for scanning via dual-energy X-ray absorptiometry (DXA). Three case studies are presented to illustrate when DXA scans can be informative to the forensic practitioner. The first case study presents an individual with observed longitudinal fractures in the weight bearing bones and DXA is used to assess bone insufficiency. BMD is found to be normal suggesting another etiology for the fracture pattern present. The second case study employed DXA to investigate suspected chronic malnutrition. The BMD results are consistent with results from long bone lengths and suggest the juvenile had suffered from chronic malnutrition. The final case study provides an example where fatal starvation in a fourteen-month infant is suspected, which supports autopsy findings of fatal starvation. DXA scans showed low bone mineral density for chronological age and is substantiated by traditional assessments of infant health. However, when dealing with skeletal remains taphonomic alterations should be considered before applying this method.

Bone Mineral Density Adult Age Estimation in Forensic Anthropology: A Test of the DXAGE Application

“…Currently, DXAGE is not recommended for forensic casework; however, the quantitative nature of BMD data eliminates the problem of observer experience and interobserver subjectivity that has been documented by numerous researchers . Moreover, DXA technology is widely available and BMD data can be generated rapidly and at low cost . General practitioner clinics, hospitals, and some veterinary hospitals routinely use BMD data and procedures for rapidly obtaining BMD parameters from isolated skeletal elements have been described .…”

<p>Bone-mineral density: clinical significance, methods of quantification and forensic applications</p>

“…BMD comprises a useful metric to explore cases of fatal starvation or neglect in juveniles. 21,98 Neglected and malnourished children have delayed skeletal maturation and weight and height values in the lower-third percentile of standard growth charts. 98 DXA can be applied in living patients and is considered ideal for children as it is quick and minimally invasive.…”

“…Apart from the clinical application of BMD, forensic medicine and anthropology use BMD for estimating sex and age, identifying pathological conditions like chronic malnutrition, and assessing diagenetic changes in bone material. [19][20][21] In addition, BMD has been used in paleoanthropological studies to assess osteoporosis in archeological populations, although taphonomic influences were acknowledged to confound BMD values. 22,23 We review factors affecting BMD and the commonest techniques used to quantify it.…”

An Analysis of Hounsfield Unit Values and Volumetrics from Computerized Tomography of the Proximal Femur for Sex and Age Estimation

“…Furthermore, studies have also attempted to leverage the link of bone density to age estimation by utilizing a variety of common clinical imaging modalities on different regions of the body including the skull , pelvis , and femur . One of the methodologies in sex and age estimation utilizes bone mineral density (BMD) as acquired from dual‐energy X‐ray absorptiometry (DEXA) . Several studies have used DEXA on the cranium, femur, or lumbar vertebra to estimate sex and/or age .…”

“…One of the methodologies in sex and age estimation utilizes bone mineral density (BMD) as acquired from dual‐energy X‐ray absorptiometry (DEXA) . Several studies have used DEXA on the cranium, femur, or lumbar vertebra to estimate sex and/or age . Other imaging modalities that capture tissue densities include CT scans which measure signal attenuation in the form of Hounsfield units .…”