Bone Mineral Density In Children Research Articles

Assessment and management of low bone mineral density in children with cerebral palsy

Cerebral palsy (CP) is an impairment in motor function and coordination due to a nonprogressive brain injury that occurs pre-, peri-, or postnatally until 2 years of age with a prevalence of one to four per 1,000 live births. Along with impaired motor function, decreased bone mineral density (BMD) in children with CP is of concern for providers. An algorithm has been created to help identify patients at risk for decreased BMD who are seen by providers. Factors included in the algorithm are medication history, fracture history, ketogenic diet, ambulation status, history of an endocrinopathy, and pubertal stage.BMD levels are measured using dual-energy x-ray absorptiometry (DXA) scans. Once a patient is identified as having decreased BMD several treatment options are available. BMD can be increased through stander use, diet, and bisphosphonate treatment. This paper serves as a summary of the current ways in which children with CP are assessed at each visit, as well as how to treat low BMD once it has been identified.

Effect of nutritional supplementation on bone mineral density in children with sickle cell disease: protocol for an open-label, randomised controlled clinical trial

IntroductionChildren with sickle cell disease show a significant decrease in bone mineral density, an increase in resting energy expenditure of more than 15%, a decrease in fat and lean mass...

Prevalence of vitamin D deficiency in children with cerebral palsy: a meta-analysis

BackgroundVitamin D deficiency stands out as a significant contributor to reduced bone mineral density in children diagnosed with CP. The objective of meta-analysis was to estimate the prevalence of vitamin D deficiency in children with CP. MethodsThis meta-analysis adhered to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guide. For CP children aged between 0 and 18 years with vitamin D deficiency, relevant articles were retrieved from PubMed, Scopus, ScienceDirect, and Cochrane. Following keywords were used: ‘cerebral palsy’, ‘children’, ‘childhood’, ‘vitamin D’, ‘vitamin D deficiency’, ‘prevalence’, and ‘frequency’. Newcastle-Ottawa Scale was used to assess methodological quality. Meta-analysis was performed using Stata 13.0. ResultsIn total, seven articles were considered suitable for inclusion in the meta-analysis out of 411 articles initially identified. These studies involved a total of 430 children diagnosed with CP, ranging in age from 0 to 18 years. Among the seven studies, two followed a cross-sectional approach, while the remaining five utilized a case-control design. Six of these studies were determined to have a low risk of bias, while one exhibited a moderate risk of bias. The combined prevalence of vitamin D deficiency in children with CP was determined to be 42.18% (95% confidence interval [CI] = 32.90% – 51.73%, I2 = 74.41%, and P < 0.001). ConclusionsIn conclusion, this meta-analysis reveals evidence of high prevalence of vitamin D deficiency in children with CP. This finding underscores the importance of addressing nutritional factors in the management of CP among pediatric populations.

Reference-Class Problems Are Real: Health-Adjusted Reference Classes and Low Bone Mineral Density.

Elselijn Kingma argues that Christopher Boorse's biostatistical theory (the BST) does not show how the reference classes it uses are objective and naturalistic. Recently, philosophers of medicine have attempted to rebut Kingma's concerns. I argue that these rebuttals are theoretically unconvincing, and that there are clear examples of physicians adjusting their reference classes according to their prior knowledge of health and disease. I focus on the use of age-adjusted reference classes to diagnose low bone mineral density in children. In addition to using the BST's age, sex, and species, physicians also choose to use other factors to define reference classes, such as pubertal status, bone age, body size, and muscle mass. I show that physicians calibrate the reference classes they use according to their prior knowledge of health and disease. Reference classes are also chosen for pragmatic reasons, such as to predict fragility fractures.

Factors Affecting Bone Mineral Density in Children and Adolescents with Systemic Lupus Erythematosus.

Patients with juvenile-onset systemic lupus erythematosus (JSLE) are at a high risk of entering adulthood with disease-related morbidities such as reduced bone mass and osteoporosis. This study aimed to evaluate the clinical characteristics of JSLE and to analyze the factors associated with low bone mineral density (BMD) in these patients. Children and adolescents diagnosed with JSLE at a single hospital in Korea were included. Demographic, clinical, and laboratory data and use of glucocorticoids and disease-modifying anti-rheumatic drugs were collected. Lumbar spine BMD Z-score was measured using dual energy x-ray absorptiometry, and lumbar spine radiographic data were collected. A total of 29 patients with JSLE were included in this study. Of these patients, seven had a lumbar spine Z-score of -2.0 or lower and were designated as the low BMD group. The differences in the clinical parameters and treatment variables between the low BMD and non-low BMD groups were compared. Higher cumulative glucocorticoid dose, longer glucocorticoid exposure, and higher cumulative hydroxychloroquine dose were associated with low BMD; the main factor was the duration of exposure. There was no significant correlation between BMD and clinical profile, SLE disease activity, or bone metabolism markers. The duration of glucocorticoid exposure, cumulative glucocorticoid dose, and cumulative hydroxychloroquine dose were risk factors for low BMD in patients with JSLE, with the main factor being duration of glucocorticoid exposure. Thus, patients with JSLE should be routinely monitored for low BMD and potential fracture risks, and glucocorticoid-sparing treatment regimens should be considered.

Physical development and bone mineral density of children with inflammatory bowel diseases

Relevance. Inflammatory bowel diseases can cause a lag in physical development and a decrease in the nutritional status of children. Therapy with glucocorticosteroids can aggravate the process of formation of the body and reduce the mineralization of bone tissue.Materials and methods. The study included 24 children aged 5 to 17 years with inflammatory bowel diseases, of which 19 patients did not use glucocorticosteroids in therapy – group 1, and group 2–5 children on hormone therapy. The groups did not differ statistically significantly in age and gender composition. In order to assess the level of physical development, an assessment of anthropometric indicators was carried out using the ANTHRO Plus program. Bone mineral density was assessed by densitometry. Statistical processing was carried out using Statistica 6.0 statistical programs and descriptive statistics methods. To compare independent groups of small volume, the method was used Mann-WhitneyResults. The evaluation of length, body weight and body mass index was carried out, as a result, it was found that the majority of patients who participated in the study had an average level of physical development in the population, no statistically significant differences were found by any criterion (p &gt; 0.05). When assessing the BMD in children with IBD who did not use hormone therapy in the treatment of diseases, it was found that the Z-Score level within the reference values was observed in 57.9% (n = 11) children, 1 (5.3%) child has below –2.49 and in 36.8% (n = 7) the Z-Score level was determined in the range from –1.00 SD to –2.49 SD. More than half of the patients in group 2 had no changes in BMD (60%; n = 3), the Z-Score value in 1 (20%) patient corresponded to the level of osteopenia and in 1 (20%) child – osteoporosis. No differences were found between the groups and depending on physical development, gender or age (p &gt; 0.05).Conclusions. It was found that children, regardless of the use of hormone therapy they have similar indicators in the levels of physical development and bone mineralization. The importance of monitoring the studied indicators for the timely prevention of changes is noted.

Association between lung function and bone mineral density in children and adolescents: Insights from the NHANES.

Bone development and lung function are integral to child and adolescent health. Both influence an individual's overall well-being and potentially affect long-term health. Utilizing a comprehensive dataset from the National Health and Nutrition Examination Survey, this study aims to elucidate the relationship between lung function and bone mineral density (BMD) in a representative sample of children and adolescents. The analysis covered 3410 participants aged 8 to 19 years. We employed weighted multivariate linear regression and restricted cubic spline curve visualizations to explore the intricate association between lung function metrics, particularly first-second expiratory volume 1 second/forced vital capacity ratio, and lumbar BMD. Our data indicated a positive association between lung function and lumbar BMD in children and adolescents. Specifically, higher lung function metrics were linked with increased lumbar BMD. This association was more pronounced in younger participants or those with a lower body mass index. A significant positive relationship exists between lung function and BMD in the pediatric population. Recognizing this association is crucial for holistic health strategies for children and adolescents. This study underscores the need for integrated health monitoring during formative years, which can influence health trajectories as these individuals transition to adulthood.

ОСТЕОПЕНИЯ КАК ПРОЯВЛЕНИЕ ИДИОПАТИЧЕСКОЙ ГИПЕРКАЛЬЦИУРИИ У ДЕТЕЙ

Idiopathic hypercalciuria (IH) can lead to the development of osteopenia and osteoporosis in childhood. Vitamin D and its receptor, encoded by the VDR gene, play a major role in maintaining normal calcium levels in bone tissue. The purpose of the study: to study the state of bone mineral density in children with idiopathic hypercalciuria and the association of vitamin D receptor (VDR) gene polymorphisms with osteopenia. Materials and methods. The study included 35 children with IH aged 5 to 17 years with a history of fractures and/or decompensated caries. The children were subjected to X-ray densitometry to calculate the Z score in the lumbar spine and proximal femurs. A group of children with IH (n=20) underwent a study of the level of 25-OH vitamin D in blood plasma and a genetic study for the presence in genetic polymorphisms of the VDR gene: BsmI Polymorphism IVS10+283G&gt;A, A-3731G (Cdx2), FokI Polymorphism; Ex4+4T&gt;C. Results. A decrease in BMD was detected in 68.6% of children with IH, while 2 patients aged 15 and 17 years had signs of osteoporosis. The homozygous Ex4+4 CC genotype of the VDR (Fokl) gene was significantly more common in patients with idiopathic hypercalciuria. For the remaining genotypes of the VDR enzyme gene, no statistically significant differences could be detected (p&gt;0.05). Conclusion. Idiopathic hypercalciuria in children often leads to a decrease in bone mineral density, which should be taken into account when treating children with this pathology. A genetic predictor of osteopenia in children with IH may be the carriage of the homozygous genotype (rare allele) Ex4+4 CC of whose VDR (Fokl) gene, the study can be used for early diagnosis and prevention of the development of osteoporosis.

The association between appendicular skeletal muscle index and bone mineral density in children and adolescents with chronic kidney disease: A cross-sectional study.

Chronic kidney disease (CKD), a pervasive public health concern, can lead to complications like sarcopenia and reduced bone mineral density (BMD). However, it is still unclear exactly how muscle mass correlates with BMD in youngsters and adolescents with CKD. We aimed to investigate the association between appendicular skeletal muscle index (ASMI) and BMD among children and adolescents with CKD. In our research, we utilized data from the National Health and Nutrition Examination Survey (NHANES) collected between 2011 and 2014 to investigate the association of ASMI with BMD among this population. The association linking ASMI with total BMD was examined through multivariate linear regression models. Furthermore, fitted smoothing curves were employed, as well as generalized additive models. Our analysis finally included 503 CKD participants aged between 8 and 19 years. We found a significant association linking ASMI with total BMD among children and adolescents with CKD. The connection persisted even after accounting for covariates. Upon subgroup analysis, there was a statistically significant association of ASMI with total BMD for both males and females, as well as for Mexican-American and non-Hispanic White populations. However, no significant association was observed in other Hispanic, non-Hispanic Black, or populations of other races. We discovered a positive correlation linking the ASMI and the total BMD in children and teenagers with CKD. In CKD patients, maintaining skeletal muscle mass may be crucial for managing and preventing renal osteodystrophy.

Bone health in children with severe cerebral palsy

AimTo describe bone health and associated factors in children with severe cerebral palsy.MethodIn a retrospective, single-centre study, we performed a comprehensive bone evaluation (including clinical, densitometric and bone biomarker assessments) of children with severe cerebral palsy.ResultsNone of the 19 included children had a normal BMCTBLH Z score, and only one had a BMDTBLH Z score greater than −2. Six children had a BMDLS Z score greater than −2. The bone biomarker data were suggestive of excessive bone remodelling. Levels of bone remodelling markers factors and densitometric variables were not significantly related. Age, weight and pubertal stage were significantly related to bone mass.DiscussionOur results highlights the insufficient increase in bone mass with age (probably due to excessive bone remodelling) and confirms the high prevalence of low bone mineral density in children with severe cerebral palsy. Possible preventive measures might include calcium + vitamin D supplementation and the systematic management of underweight and delayed puberty. Bone remodelling markers might be of value for follow-up.

Comparison of Bone Mineral Density in Children and Adolescents on CT Versus DEXA Scan.

Retrospective cross-sectional. To determine associations between Hounsfield Units (HU) within a Region of interest (ROI) on CT scans and Dual Energy X-ray Absorptiometry (DEXA) measurements in children and adolescents. HU on CT scans as a proxy for bone mineral density (BMD) is widely used in adults. However, the utility of CT as a proxy for BMD have not been evaluated in children and adolescents. Patients younger than 18 years with a lumbar spine CT scan and a DEXA within 6 months of each other were identified. A ROI was used to measure the HU at each lumbar vertebral body on mid-axial cuts. Charts were reviewed for demographics, medical co-morbidities and DEXA reports. Correlation coefficients were calculated between mean DEXA Z-score and HU value. Patients were also stratified by Z-score (≥ -1.0, between -1.0 and -2.0, and ≤-2.0) and matched by age and BMI to a cohort of healthy children and compared. A moderate correlation between mean DEXA Z-score and mean HU on CT was found (r2=0.42, P<0.001). After matching for age and BMI, 21 patients in each group between the age of 4 and 17 years were analyzed. The mean HU value of the control group was 231.69. When stratified by Z-score (≥ -1.0, between -1.0 and -2.0, and ≤-2.0), the mean HU values were 244.59, 216.50, and 176.54, respectively. Patients with a Z-score of ≤-2.0 had a significantly lower mean HU than age matched controls. HU on lumbar CT in children and adolescents with DEXA Z-scores less than -2.0, were lower when compared to healthy age and BMI matched controls. This study suggests that HU on opportunistic CT scans of the spine may be used as a reasonable proxy for BMD in the pediatric population.

Bone mineral density in children with congenital adrenal hyperplasia presenting to tertiary care hospital from LMIC

Bone mineral density in children with congenital adrenal hyperplasia presenting to tertiary care hospital from LMIC

Decrease in bone mineral density in children with cystic fibrosis: dynamics over 15 years

Decrease in bone mineral density in children with cystic fibrosis: dynamics over 15 years

THU138 The Association Between Irisin And Anthropometric And Metabolic Parameters In Obese Children And Adolescents

Abstract Disclosure: S. Kim: None. S. Kim: None. S. Park: None. S. Sim: None. S. Kim: None. M. Ahn: None. C. Won-kyoung: None. C. Kyoung Soon: None. M. Jung: None. B. Suh: None. Background: Irisin is a myokine secreted from skeletal muscle that plays an important role in the regulation of adipokine secretion and the differentiation of osteoblast and osteoclasts. Irisin has been shown to increase browning of adipose tissue, thermogenesis, energy expenditure, and insulin sensitivity. The aim of this study was to evaluate the relation of serum irisin level with metabolic, anthropometric parameters and bone mineral density in children and adolescents. Methods: This study included 103 Korean children and adolescents in a single center: 49 (47.6 %) obese participants with a body mass index (BMI) ≥95th percentile and 54 (52.4%) healthy control with BMI 15-85th percentile. Fasting serum irisin was quantitatively assayed by ELISA. Lipid profile, fasting blood glucose, fasting insulin, the homeostasis model assessment of insulin resistance (HOMA-IR), Tryglyceride and glucose (TyG) index, osteocalcin and 25-hydroxyvitamin D3 were measured as metabolic parameters. Bone mineral density (BMD) was performed by dual energy X-ray absorptiometry (DXA) in 33 healthy subjects. Results: Serum irsin was significantly higher in obese group than in control group (mean 18.1 ± 3.5 vs 16.2 ± 2.0ng/mL; P = 0.002). There was no significant difference in serum irisin levels between prepubertal and pubertal subjects. In the all participants, irisin level was positively correlated with height SDS (r = 0.24; P = 0.02), BMI SDS (r = 0.37; P &amp;lt;0.001), HOMA-IR(r = 0.21; P = 0.04) and osteocalcin (r = 0.27; P = 0.006). Serum irisin level was negatively correlated with HDL cholesterol (r = -0.29; P = 0.005) and positively correlated with total body less head (TBLH) Z-score (r = 0.40, P = 0.03). Conclusions: This study showed the association between irisin levels with BMI standard deviation score, HOMA-IR and HDL cholesterol. Our data showed a positive correlation between irisin levels and BMD in healthy subjects. Further studies are needed to clarify the mechanisms by which irisin could affect glucose/lipid metabolism and bone metabolism. Presentation: Thursday, June 15, 2023

A 20-week exercise program improved total body and legs bone mineral density in children with overweight or obesity: The ActiveBrains randomized controlled trial

ObjectivesThe aim of this study was to investigate the effect of a 20-week exercise program on bone mineral parameters in children with overweight or obesity. DesignRandomized controlled trial. MethodsThis study took part from November 21, 2014, to June 30, 2016, in Granada, Spain. A secondary analysis of this parallel-group randomized controlled trial was performed with 77 children with overweight or obesity (9.9 ± 1.2, 65 % boys) who were randomly allocated to exercise or control group. All participants received lifestyle recommendations. The control group continued their usual routines, whereas the exercise group attended a minimum of 3 supervised 90-minute sessions/week of aerobic plus resistance training for 20 weeks. A whole-body scan by dual-energy X-ray absorptiometry was carried out to obtain body composition at total body less head, arms, lumbar spine, pelvis, and legs. ResultsParticipants in the exercise group acquired significantly higher total body aBMD (mean z-score [95 % confidence intervals, CI], 0.607 [0.522–0.692]) compared with the participants in the control group (mean z-score, 0.472 [0.388–0.556]); difference between groups, 0.135 standard deviations [95 % CI 0.015–0.255], and legs aBMD (mean z-score, 0.629 [0.550–0.708]); control group (mean z-score, 0.518 [0.440–0.596]); difference between groups, 0.111 [0.001–0.222]; all p < 0.05. There were no significant differences between exercise group and control group at the remaining evaluated regions (p > 0.05). ConclusionsA 20-week non-specifically bone-targeted exercise program induced a small, yet significant, improvement on total body and legs aBMD in children with overweight or obesity. Future studies should investigate the interaction of weight status in the bone response to exercise programs. Trial registrationProspectively registered in ClinicalTrials.gov Identifier: NCT02295072.

Association between urinary methylparaben level and bone mineral density in children and adolescents aged 8-19 years.

Previous epidemiological study has explored a positive association between methylparaben (Mep) and bone mineral density (BMD) in adults. Evidence linking Mep and BMD in children and adolescents is very limited. This study examined the association between Mep and BMD in children and adolescents aged 8-19 years. In this cross-sectional study, 1830 children and adolescents aged 8-19 years from NHANES 2011-2016 were analyzed. Mep was ln-transformed for analysis of the skewed distribution. Multiple linear regression analyses were performed to evaluate Mep's association with BMD (containing total BMD, trunk bone BMD, pelvis BMD, lumbar spine BMD, and thoracic spine BMD). Moreover, a generalized additive model (GAM) and a fitted smoothing curve (penalized spline method) were conducted to explore the exact shape of curve between them. In the fully adjusted model, ln-transformed Mep and BMD showed an independent and positive association (total BMD (β = 0.003, 95% CI (0.001, 0.005), P = 0.01), trunk bone BMD (β = 0.002, 95% CI (0.000, 0.005), P = 0.04), pelvis BMD (β = 0.004, 95% CI (0.001, 0.008), P = 0.02), lumbar spine BMD (β = 0.005, 95% CI (0.001, 0.008), P = 0.01), thoracic spine BMD (β = 0.003, 95% CI (0.001, 0.005), P = 0.02)) and a linear association. Subgroup analysis showed positive association between ln-transformed Mep and BMD. Furthermore, the positive association was significant in females and children aged 12-19 years (P for trend < 0.05). This study is the first study to find evidence demonstrating that exposure to Mep may be positively associated with BMD in children and adolescents aged 8-19 years. Validation of our findings will need further research.

Factors of reduced bone mineral density in children with Turner syndrome

Decreased bone mineral mass is one of the significant somatic problems for adolescents with Turner syndrome. The results of our own study, which estimates the state of bone mineral density in children with Turner syndrome depending on age, karyotype variant, spontaneous or stimulated onset of sexual development are present in the publication. A high frequency of bone mineral density deficiency in patients with Turner syndrome was established, regardless of the presence of puberty. Changes in bone density in girls with spontaneous puberty are less common. The difference in bone mineral density between patients with Turner syndrome and the control group from the age of 11 years was shown. Positive effect of replacement estrogen therapy on bone tissue condition in Turner syndrome is shown.

Evaluation of Bone Mineral Density in Children with Celiac Disease

Background: Osteoporosis is a known entity in individuals with celiac disease (CD). Objectives: The aim of this study was to evaluate bone mineral density (BMD) measurements in children with CD. Methods: This was a retrospective design study in a tertiary hospital in Turkey. Results: Totally 106 patients were included, and the mean age was 10.2 ± 3.9 years. The mean L1-L4 Z score was 0.730 ± 0.197 (based on sex and height in Turkish children). About 20.7% (n = 22) had a history of at least one fracture and/or bone pain. Bone mineral density values obtained from lumbar (L1-L4) vertebrae were significantly lower in patients with a prior fracture and/or bone pain compared to the patient group without a fracture (0.822 ± 0.242 g/cm2 vs 0.706 ± 0.178 g/cm2, respectively; P = 0.047). L1-L4 Z score (based on sex and height in Turkish children) was lower in patients with a body mass index (BMI) SDS value below -2 (moderately or severely malnourished) than those with a BMI SDS above -2 (0.02 ± 1.19 vs 1.4 ± 1.82, respectively; P = 0.014). A moderate positive correlation (r = 0.547; P &lt; 0.01) was found between somatomedin-C (IGF-1) level and L1-L4 BMD (g/cm2) measurement. It was remarkable that low BMD was not identified in any patients using L1-L4 Z-score by height and L1-L4 Z-score by age of Turkish children. Nine (8.5%) patients were found to have low BMD using the United States (US) age- and sex-specific L1-L4 Z-score from the GE Healthcare Lunar iDXA system. Conclusions: Bone mineral density should be screened considering risk factors for suboptimal bone health in children with celiac disease. False "normal" BMD interpretations can be avoided by taking into account the model of the BMD measuring device and by using the device's normal ranges in case of inconsistency with the Turkish reference values.

Evaluation of bone mineral density and bone turnover in children on anticoagulation.

Childhood and adolescence are critical periods of bone mineral acquisition. Children on anticoagulation (AC) might have an increased risk for reduced bone mineral density (BMD). Risk factors for impaired bone accumulation include chronic diseases, immobility, and medication. Vitamin K (VK) deficiency reflected by undercarboxylated osteocalcin levels (ucOC) has been identified as a predictor of osteoporosis and fractures. Data on bone health in children under AC are sparse. To evaluate BMD in children on AC and characterize the risk factors of low BMD, including VK and Vitamin D (VD) status. Single-center cross-sectional study of clinical, biochemical, and densitometric parameters. Assessment of VK surrogate parameters included ucOC and matrix gla protein (MGP). A total of 39 children (4-18 years; 12 females) receiving AC were included, 31 (79%) on VK antagonists and 8 (21%) on direct oral anticoagulants. Overall, BMD was decreased for both the lumbar spine (LS; -0.7SDS) and total body less head (TBLH; -1.32SDS) compared with pediatric reference data. Significant associations were found between early pubertal development and TBLH-BMD, and between BMI and LS-BMD. VK surrogate parameters were highly related to patients' age and pubertal development. Neither serum parameters nor AC-related factors predicted BMD. VD was detected in 10/39 patients with lower values during puberty. Our data indicate BMD reduction in pediatric patients on AC. Although AC-related factors did not predict reduced BMD, low BMI and pubertal stages represented important risk factors. Awareness of risk factors for low BMD and high prevalence of VD deficiency during puberty could contribute to the improvement of bone health in this vulnerable patient group.

Liver Fat, Bone Marrow Adipose Tissue, and Bone Mineral Density in Children With Overweight.

Hepatic steatosis is associated with decreased bone mineral density (BMD). Bone marrow fat fraction (BMFF) could play a role in this relationship in children with obesity. The objectives of this work were (i) to examine the relationship between the lumbar spine (LS) BMFF and BMD, and (ii) to explore the mediating role of LS-BMFF on the relationship between percentage hepatic fat with LS-BMD in preadolescent children with overweight/obesity. Hepatic fat and LS-BMFF (magnetic resonance imaging) and areal LS-BMD (LS-aBMD, dual-energy x-ray absorptiometry) were measured in 106 children (aged 10.6 ± 1.1 years, 53.8% girls) with overweight/obesity. LS-BMFF was inversely associated with LS-aBMD (r = -0.313; P = .001) and directly related with percentage hepatic fat (r = 0.276; P = .005). LS-BMFF was significantly greater in children with than without hepatic steatosis (P = .003; Cohen's d: 0.61; 95% CI, -0.21 to 1.0), while no significant difference was seen between children with overweight and those with obesity (P = .604; Cohen's d: 0.16; 95% CI, -0.21-0.55). Mediating analysis indicated that LS-BMFF is an important mediator (50%) in the association of hepatic fat with lower LS-aBMD (indirect effect: β = -.076; 95% CI, -0.143 to -0.015). These findings suggest that hepatic steatosis, rather than overall excess adiposity, is associated with greater bone marrow adipose tissue in preadolescent children with overweight/obesity, which in turn, is related to lower BMD. Hepatic steatosis could be a potential biomarker of osteoporosis risk, and a therapeutic target for interventions that aim to reduce not only hepatic steatosis, but for those designed to improve bone health in such children.