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  • Population Study Article
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Relationship between inflammatory indicators and bone mineral density in preschool children

Pediatric Research (2025)Cite this article

Abstract

Background

To investigate the relationship between inflammatory indicators and bone mineral density in preschool children.

Methods

The study population consisted of 393 preschool children aged 4–6 years. NLR, PLR, SII, and PIV were calculated based on lymphocyte counts, neutrophil counts, platelet counts and monocyte counts derived from a complete blood count test. The relationships between inflammatory indicators with BMD increment were analyzed using covariance analysis. ROC curve analysis was used to find a cut-off point for inflammatory indicators that can be assessed for BMD insufficiency. Multiple linear regression models were used to analyze the association between inflammatory indicators and bone metabolism markers.

Results

NLR (p-trend = 0.010), PIV (p-trend = 0.004) and SII (p-trend = 0.015) were positively associated with BMD increments, whereas PLR was not. ROC curve analysis showed that PIV (AUC = 0.58, 95% CI 0.52–0.64) and SII (AUC = 0.56, 95% CI 0.50–0.62) can predict low BMD, with PIV having the highest ability to predict. PIV was positively associated with osteocalcin and 25⁃(OH)D, whereas SII was positively associated with osteocalcin only.

Conclusion

PIV, SII, and NLR were positively associated with BMD increment. The study suggests that PIV holds promise as a potential tool for predicting the risk of BMD insufficiency in preschool children.

Impact

  • After controlling for various confounders during a 1-year observation period, significant associations were found between the inflammatory indicators NLR, SII, and PIV and increased left-sided heel BMD in preschool children, exploring the finding that chronic inflammation plays a different role in children’s bone health than it does in adults.

  • Our findings found that PIV holds promise as a potential tool for predicting the risk of BMD insufficiency in preschool children. Focusing on bone mineral density in preschool children, this study provides valuable evidence and fills a gap in research on this age group.

  • In the study, osteocalcin was also found to be positively correlated with SII and PIV and 25⁃(OH)D was positively correlated with PIV. They may provide potential avenues to enhance understanding of the effects of inflammation on bone.

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Fig. 1: Study flowchart.
Fig. 2: The trends in BMD increment and BMC increment at different levels of inflammation.
Fig. 3: ROC curves for the association of NLR, PLR, SII, and PIV with low BMD in preschool children.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank all research members involved in the data collection of the study.

Funding

This work was supported by the Fundamental Research Funds for the Central Universities (grant number lzujbky-2023-40).

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Authors and Affiliations

  1. Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China

    Ying Hu, Xue-yi Jin, Xue-qian Mao, Chao Wang, Chi-yu Tian, Ke-wei Liu, Xin-ge Lv & Li-peng Jing

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  1. Ying Hu
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Contributions

Y.H., X-Y.J., and X-Q.M. analyzed the data. C.W., C-Y.T., K-W.L., and X-G.L. checked the relevant literature. All authors contributed to the acquisition and interpretation of the data. Y.H. drafted the first version of the manuscript. All authors critically revised the manuscript for important intellectual content, ultimately approved the version to be published, and agreed to take responsibility for all aspects of the work.

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Correspondence to Li-peng Jing.

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Hu, Y., Jin, Xy., Mao, Xq. et al. Relationship between inflammatory indicators and bone mineral density in preschool children. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04665-y

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