The New York City Chief Medical Examiner has determined that accused sex trafficker Jeffrey Epstein died by suicide.

The Associated Press reported on Twitter that the medical examiner had released the autopsy findings, and determined that Epstein, 66, hanged himself in his cell at the Metropolitan Correctional Facility.

According to the New York Times, officials said that Epstein had made a makeshift noose with a bed sheet tied to the top bunk in his cell, and then “knelt toward the floor with enough force that he broke several bones in his neck,” the report states.

Epstein was found unresponsive early Saturday morning and later pronounced dead at a hospital. Questions have surrounded the circumstances of his death, with sources telling the Washington Post earlier this week that Epstein had bone fractures in his neck. One of the fractures, in the hyoid bone, is sometimes the result of suicide by hanging but is more often seen in cases of homicidal strangulation, an expert told the newspaper. The medical examiner’s findings would appear to explain how Epstein suffered neck fractures as a result of a hanging suicide.

The medical examiner’s office did not immediately respond to a request for comment from CrimeOnline.