# How does rickets impair locomotor development in children? Analysis of the trabecular bone microarchitecture of the distal radial metaphysis

Antony Colombo, Sharon Kuo, Gregorio Marchiori, Melania Maglio, Lucia Martini, Milena Fini, Matteo Bettuzzi, Maria Pia Morigi, Alex Ireland,

Timothy M Ryan, et al.

► To cite this version:

Antony Colombo, Sharon Kuo, Gregorio Marchiori, Melania Maglio, Lucia Martini, et al. How does rickets impair locomotor development in children? Analysis of the trabecular bone microarchitecture of the distal radial metaphysis. 49th Annual North American Meeting, Mar 2022, Denver (CO), United States. hal-05064629

HAL Id: hal-05064629

https://hal.science/hal-05064629v1

Submitted on 12 May 2025

HAL is a multi-disciplinary open access
archive for the deposit and dissemination of sci-
entific research documents, whether they are pub-
lished or not. The documents may come from
teaching and research institutions in France or
abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est
destinée au dépôt et à la diffusion de documents
scientifiques de niveau recherche, publiés ou non,
émanant des établissements d'enseignement et de
recherche français ou étrangers, des laboratoires
publics ou privés.

<figure><img src="image_1.png" /></figure>
# How does rickets impair locomotor development in children?
## Analysis of the trabecular bone microarchitecture of the distal radial metaphysis.

Antony Colombo¹,², Sharon Kuo³, Gregorio Marchiori⁴, Melanie Maglio⁴, Lucia Martini⁴, Milena Fini⁴, Matteo Bettuzzi⁵, Maria Pia Morigi⁵, Alex Ireland⁶, Timothy M. Ryan³, Maria Giovanna Belcastro¹

¹Department of Biological, Geological and Environmental Sciences, University of Bologna, ²Department of Life and Earth Sciences, EPHE-PSL University, ³Department of Anthropology, Pennsylvania State University, ⁴Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, ⁵Department of Physics and Astronomy, University of Bologna, ⁶Musculoskeletal Science and Sports Medicine Research Centre, Department of Life Sciences, Manchester Metropolitan University.

## INTRODUCTION

### TRABECULAR BONE
### MICROARCHITECTURE & DEVELOPMENT

* Trabecular bone microarchitecture (TBMA) adapts to variations in loading experienced during locomotion [1].

* The crawling phase of human ontogeny is an important step before bipedal walking in children [2] which implies biomechanical modification on the wrist for a relatively short period of time.

<figure><img src="image_2.png" /><figcaption>Fig. 1 – Individual F9 with rickets macroscopical bone signs: [a] radius with a flared and raveled distal metaphysis, [b] bowed tibia and fibula with deformed metaphyses, [c] deformed ribs with enlarged and flared metaphyses.</figcaption></figure>

### TBMA & RICKETS

* In most cases, **rickets** is due to a severe vitamin D deficiencies and mainly affects infants from 0.5 to 2 years old, the period of development of their locomotor abilities [3].

* Rickets is known to **delay** the psychomotor development [4].

* **Paleopathological** main signs [3] related to rickets are mainly long bone bowing, metaphysis swelling, flaring and raveling (Fig. 1).

**GOAL:** To understand whether and how the locomotor development is impaired in this pathological context.

## MATERIAL & METHODS

<figure><img src="image_3.png" /></figure>

### SAMPLE

* Certosa identified skeletons collection, Univ. Bologna [5]

* **Distal radial metaphysis** (Fig. 2) of 40 children, [0-38] months old: 20 individuals without bone pathological signs, 20 individuals with signs consistent with rickets.

### µCT-SCANS

* Resolution of **9 or 18 µm** (bone size dependent)

* SkyScan Brüker 1276 - acquisition protocol

* filter: 0.5 Al, source voltage: 70 kV, source current: 141 µA, exposure time: 495 ms, rotation step: 0.5°, 360° Rotation mode, frame averaging: 3.

### ANALYSIS PROTOCOL

* **RDN segmentation** [6]

* **Medtool 4.4** image processing (Fig. 3) & parameters quantified [7]: bone volume fraction (BV/TV), degree of anisotropy (DA), trabecular thickness (Tb.Th) and spacing (Tb.Sp).

<figure><img src="image_4.png" /><figcaption>Fig. 3 (top) – Image processing: from the original µCT-scan to the usable image for trabecular parameters quantification (resolution of 18 µm, individual F15 – 13.1-month-old female, without bone pathological signs).</figcaption></figure>

<figure><img src="image_5.png" /><figcaption>Fig. 4 (bottom) – Original µCT-scan (left) and segmented image from a pathological individual (resolution of 18 µm, individual F9 – 13.3-month-old female, with bone pathological signs).</figcaption></figure>

## RESULTS

<figure><img src="image_6.png" /><figcaption>Fig. 5 – Comparison of the quantified microarchitectural parameters per age group (A: [0-9], B: [9-18], C: ≥ 18 months old) between normal and pathological samples (Wilcoxon non-parametric test: *p<0.05, **p<0.01, ***p<0.001)</figcaption></figure>

* In addition of the cortical bone modifications, the TBMA shows a **very different organizational pattern** (Fig.4).

* In the whole radius distal metaphysis, the pathological sample shows a **lower BV/TV** and **more variable DA** for the three age groups. **Tb.Sp** and **Tb.Th** are lower for the youngest age group and significantly **higher** for the age group B (Fig. 5).

* The TBMA organization (Fig. 6) for the pathological individuals is **similar to** the one of **younger individuals** from the normal sample. High Tb.Th values and a BV/TV concentric organization is observed for the group B in the normal sample and the group C in the pathological one. DA shows a very variable organization for the pathological individuals.

<figure><img src="image_7.png" /><figcaption>Fig. 6 – Comparison of BV/TV, DA and Tb.Th 3D maps of a normal and a pathological individual of similar age from each age group. (Normal sample: F17, 7-month-old female for the group A; F15, 13.1-month-old female for the group B; M11, 23.7-month-old male for the group C. Pathological sample: F54, 6-month-old female for the group A; F9, 13.3-month-old female for the group B; M3, 23.2-month-old male for the group C.)</figcaption></figure>

## DISCUSSION & CONCLUSION

* **REFERENCES** [1] Frost, H.M., 1990. Skeletal structural adaptations to mechanical usage (SATMU): 2. Redefining Wolff's law: The remodeling problem. *Anat. Rec.* 226, 414-422. [2] Adolph, K.E., Karasik, L.B., Tamis-Lemonda, C.S., 2009. Motor skill, in: Bornstein, M.H. (Ed.), *Handbook of Cultural Developmental Science*. Taylor and Francis Press, pp. 61-88. [3] Brickley, M., Ives, R., 2008. *The bioarchaeology of metabolic bone disease*. Elsevier, Academic Press, Oxford. [4] Agarwal, A., Gulati, D., Rath, S., Walia, M., 2009. Rickets: A cause of delayed walking in toddlers. *Indian J. Pediatr.* 76, 269-272. [5] Belcastro, M.G., Bonfiglioli, B., Pedrosi, M.E., Zuppello, M., Tanganelli, V., Mariotti, V., 2017. The History and Composition of the Identified Human Skeletal Collection of the Certosa Cemetery (Bologna, Italy, 19th-20th Century). *Int. J. Osteoarchaeol.* 27, 912-925. [6] Kuo, S., Demars, L.J., Yazdani, A., Cherukuri, V., Sun, Y., Colombo, A., Monga, V., Ryan, T.M., 2022. Applications of a regularized deep network micro-CT image auto-segmentation approach to morphological data. *Poster presentation 91st AABA meeting, session 2, March 24.* [7] Gross, T., Kivell, T.L., Skinner, M.M., Nguyen, N.H., Pahr, D.H., 2014. A CT-image-based framework for the holistic, Shaw, C.N., 2012. Unique Suites of Trabecular Bone Features Characterize Locomotor Behavior in Human and Non-Human Anthropoid Primates. *PLoS ONE* 7, e41037.

* **FUNDING** This project has received funding from the European Union's Horizon 2020 research and innovation program under the Marie Skłodowska-Curie Actions grant agreement N° 886380.