Epidemiology of low bone mineral density and fractures in children with severe cerebral palsy: a systematic review (original) (raw)
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ABSTRACT Background: Long bone fracture is a common problem in non-ambulatory CP children and many of those who sustain a fracture will sustain repeated fractures. Objective: To evaluate BMD values in a sample of patients who had CP as an indirect indicator of bone fracture and analyze critically the clinical predictors for the fracture of a long bone in those patients. Methodology: The study population consisted of 30 children and adolescents with CP and 20 age and sex matched control group. Full history taking with special stress on feeding practice, antiepileptic drug, history of fracture and the physiotherapy programs. The patients were evaluated according to Gross Motor Functional Classification (GMFC) scale, and those with only scale 3, 4 and 5 were included. Anthropometric evaluation and musculoskeletal assessments were performed. Blood samples were obtained from the patients and control groups for measurements of calcium (Ca), phosphorus (Ph), and alkaline phosphatase. Bone ...
Epilepsia, 2012
Purpose: The present study aimed to assess bone mineral density (BMD) in a population of children and adolescents with cerebral palsy and mental retardation with or without epilepsy. Methods: One hundred thirteen patients (63 male and 50 female) were recruited for evaluation. Patients were divided in three groups: 40 patients (group 1) were affected by cerebral palsy and mental retardation; 47 (group 2) by cerebral palsy, mental retardation, and epilepsy; and 26 (group 3) by epilepsy. The control group consisted of 63 healthy children and adolescents. Patients underwent a dual-energy x-ray absorptiometry (DEXA) scan of the lumbar spine (L1-L4), and z-score was calculated for each patient; t-score was considered for patients 18 years of age and older.
Bone health impairment in patients with cerebral palsy
Archives of Osteoporosis, 2020
Bone health problems may be related to the nutritional deficit in pediatric patients with cerebral palsy. It is common to find asymptomatic vertebral fractures when they have low bone mineral density. Fat mass deficit could be related to a lower bone mineral density and a higher risk of vertebral fractures. Objectives To study the bone health of patients with CP and its relationship with neurological and nutritional status. Purpose Cerebral palsy (CP) is the most common cause of motor disability in pediatric age. Methods Cross-sectional, observational, descriptive, and analytical study in which patients with CP between 4 and 5 years with Gross Motor Function Classification System (GMFCS) grades III-IV-V were included. It was carried out: survey, anthropometric study, bioimpedanciometry (BIA), and bone densitometry. Patients with low bone mineral density (BMD Z score less than − 2.0) underwent lumbar radiography looking for vertebral fractures to be diagnosed with osteoporosis. Results Total sample: 51 patients (51.0% women). Mean age: 11.0 ± 0.5 years. BMD Z score average: − 2.1 (95% CI − 2.5, − 1.7). BMD Z score according to GMFCS: grade III − 1.6 (− 2.2; − 1.), grade IV − 1.6 (− 2.4; − 0.9), grade V − 3.1 (− 3.9, − 2.2) (p = 0.013). Bone health classification according to the International Society for Clinical Densitometry was: 47.1% normal, 52.9% low BMD. Relationship between low BMD and low fat mass (p = 0.030) and low cell mass (p = 0.040) was found. Prevalence of vertebral fractures in lumbar radiography: 25.9%, increasing as the degree of neurological involvement. Vertebral fractures were found in 5/13 GMFCS grade V, 2/6 GMFCS grade IV, and 0/10 GMFCS grade III. Conclusions Bone health in the pediatric population with CP is compromised in relation to the degree of neurological involvement and nutritional status. Those patients with moderate-severe cerebral palsy and low BMD seem to present an increased risk of fracture.
Osteoporosis International, 2014
This study assessed distal femur and lumbar spine bone mineral density (BMD) Z-scores in children with cerebral palsy. BMD z-score was lower in non-ambulatory than in ambulatory children. Somewhat surprisingly, among ambulatory children, those with better walking abilities had higher BMD z-score than those with more impaired walking ability. Introduction Children with cerebral palsy (CP) have increased risk for low bone mineral density (BMD). The aim was to explore the difference in BMD at the distal femur and lumbar spine between ambulatory and non-ambulatory children with CP and the relationship between vitamin D status and BMD.
Low bone mineral density in ambulatory persons with cerebral palsy? A systematic review
Disability and Rehabilitation, 2018
Purpose: Non-ambulatory persons with cerebral palsy are prone to low bone mineral density. In ambulatory persons with cerebral palsy, bone mineral density deficits are expected to be small or absent, but a consensus conclusion is lacking. In this systematic review bone mineral density in ambulatory persons with cerebral palsy (Gross Motor Function Classification Scales I-III) was studied. Materials and methods: Medline, Embase, and Web of Science were searched. According to international guidelines, low bone mineral density was defined as Z-score À2.0. In addition, we focused on Z-score-À1.0 because this may indicate a tendency towards low bone mineral density. Results: We included 16 studies, comprising 465 patients aged 1-65 years. Moderate and conflicting evidence for low bone mineral density (Z-score À2.0) was found for several body parts (total proximal femur, total body, distal femur, lumbar spine) in children with Gross Motor Function Classification Scales II and III. We found no evidence for low bone mineral density in children with Gross Motor Function Classification Scale I or adults, although there was a tendency towards low bone mineral density (Z-score À1.0) for several body parts. Conclusions: Although more high-quality research is needed, results indicate that deficits in bone mineral density are not restricted to non-ambulatory people with cerebral palsy. ä IMPLICATIONS FOR REHABILITATION Although more high-quality research is needed, including adults and fracture risk assessment, the current study indicates that deficits in bone mineral density are not restricted to non-ambulatory people with CP. Health care professionals should be aware that optimal nutrition, supplements on indication, and an active lifestyle, preferably with weight-bearing activities, are important in ambulatory people with CP, also from a bone quality point-of-view. If indicated, medication and fall prevention training should be prescribed.
Assessment of bone density in children with cerebral palsy by areal bone mineral density measurement
The Turkish journal of pediatrics
The aim of this cross-sectional study was to investigate the frequency of decreased areal bone mineral density (aBMD) among patients with cerebral palsy (CP), as estimated by using various aBMD Z-score adjustment methods. In addition, this study examined factors related to decreased aBMD scores. One hundred and two children between the ages of 3.2 and 17.8 years were examined. In patients with severe CP, the incidences of decreased aBMD according to various adjusting methods based on decimal age, bone age, height age, and height-for-age Z-score (HAZ) were 79.5%, 69.5%, 51.9%, and 38.3%, respectively. Abnormal levels of calcium, phosphorus, alkaline phosphatase, parathyroid hormone, or anticonvulsant were not predictive for a decreased aBMD. Mean aBMD Z-scores were significantly lower in all aBMD Z-score adjustment methods in patients with severe CP compared to patients with mild-to-moderate CP, except for the adjustment method based on HAZ.
Motor impairment and skeletal mineralization in children with cerebral palsy
JPMA. The Journal of the Pakistan Medical Association, 2017
To evaluate the bone mineral density and the effect of motor impairment on bone mineral density in children with cerebral palsy. The cross-sectional study was conducted at the Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan, from January 2013 to January 2015. Children diagnosed with cerebral palsy were sampled by non-probability purposive sampling from the Cerebral Palsy clinic. On the basis of Gross Motor Function Classification level of motor impairment, the children were divided into mild Cerebral Palsy (level 1 & 2) and moderate to severe Cerebral Palsy (level 3-5) groups. Bone mineral density z-score was measured at lumbar spine with Dual Energy X-Ray Absorptiometry at L1-L4 lumbar vertebra. Data was analysed using SPSS 20. Of the total 108 children selected, 18(16.6%) had to be excluded due to poor nutrition status or deranged serum chemistry, while in 4(3.7%) children Dual Energy X-ray Absorptiometry scan was not done on technical grounds. Of the remai...
Low bone mass in patients with motor disability: prevalence and risk factors in 59 Finnish children
Developmental Medicine & Child Neurology, 2010
AIM Children with motor disabilities are at increased risk of compromised bone health. This study evaluated prevalence and risk factors of low bone mass and fractures in these children. METHOD This cross-sectional cohort study evaluated bone health in 59 children (38 males, 21 females; median age 10y 11mo) with motor disability (Gross Motor Function Classification System levels II-V). Bone mineral density (BMD) in the lumbar spine was measured with dual-energy X-ray absorptiometry; BMD values were corrected for bone size (bone mineral apparent density [BMAD]) and skeletal maturity, and compared with normative data. Spinal radiographs were obtained to assess vertebral morphology. Blood biochemistry included vitamin D concentration and other parameters of calcium homeostasis. RESULTS Ten children (17%) had sustained in total 14 peripheral fractures; lower-limb fractures predominated. Compression fractures were present in 25%. The median spinal BMAD z-score was)1.0 (range)5.0 to 2.0); it was)0.6 in those without fractures and)1.7 in those with fractures (p=0.004). Vitamin D insufficiency was present in 59% of participants (serum 25-hydroxyvitamin D <50nmol ⁄ l) and hypercalciuria in 27%. Low BMAD z-score and hypercalciuria were independent predictors for fractures.