Skeletal and Adipose Manifestations of Stress in a Contemporary Pediatric Sample

Introduction: Adverse experiences leading to physiological disruptions (stress) in early life produce cascade effects on various biological systems, including the endocrine and metabolic systems, which, in turn, shape the developing skeletal system. To evaluate the effects of stress on adipose and skeletal tissues, we examine the relationship between skeletal indicators of stress (porotic hyperostosis [PH] and cribra orbitalia [CO]), bone mineral density (BMD), vertebral neural canal (VNC) diameters, and adipose tissue distribution in a contemporary pediatric autopsy sample.

Methods: Data is from 702 (409 males, 293 females) individuals from a pediatric (0.5-20.9 years) autopsy sample from New Mexico who died between 2011 and 2022. Data includes visceral adipose tissue (VAT) in the abdomen, heart, and liver, CO/PH, VNC size of the fifth lumbar vertebra, and BMD.

Results: We find that adipose tissue distribution and location are differentially associated with CO/PH, BMD, and VNC size; VNC size is smaller, and liver adiposity is higher in those with CO/PH. Further, increased VAT and small VNC size are associated with PH presence and low BMD. Body mass index categories do not correspond with porous cranial lesion presence.

Conclusions: This paper provides evidence for the complex relationship between skeletal markers of early-life stress (CO/PH, reduced VNC size, low BMD) and endocrine system function. VAT distribution and VNC size are partly shaped by stressors during gestation, likely through alterations of the HPA axis. It is possible that alterations of the HPA axis due to gestational stress also shape the expression of porous cranial lesions during exposure to childhood stressors.