Bone-mineral density: clinical significance, methods of quantification and forensic applications

Abstract

Bone-mineral density (BMD) is a measure of the inorganic mineral content in bone, and is one of the more informative assessments of bone quality in both clinical studies and forensic investigations. Several factors, such as age, sex, disease, genetics, and lifestyle, affect BMD measurements, and normative standards must be applied for specific groups and individuals. One of the most common disorders associated with low BMD is osteoporosis and increased fracture risk, due to a decrease in bone strength and an increase in bone fragility. Medical conditions like diabetes or hyperthyroidism and other parameters like peak bone mass and postmenopausal estrogen deficiency also impact BMD. Single-and dual-energy photon absorptiometry, quantitative computet tomography, and magnetic resonance imaging are some of the technological modalities for BMD quantification, and each presents distinct advantages and limitations, depending on the purpose of the analysis, the specific characteristics of the individual, the bone site under examination, and the equipment and trained personnel available. Recently, BMD values were applied to forensic medicine in a variety of scenarios ranging from age and sex estimation to the assessment of malnutrition and the use of finite-element modelling. Despite technical and methodological inconsistencies reported in the literature on BMD readings, there is scope for expanding the use of this variable in forensic settings.