METHOD We examined 56 children with spastic CP (10 diplegia, 12 hemiplegia and 34 quadriplegia) aged 4 to 12 years (35 males, 21 females) and 29 typically developing children. Children with CP were stratified into three groups based on Gross Motor Function Classification System (GMFCS) levels I to II (n=22), III (n=8), and IV to V (n=26). Growth and clinical variables, bone markers, distal femur and lumbar areal bone mineral density (BMDa), and calcaneal broadband ultrasound attenuation (BUA) were assessed. RESULTSThe femur BMDa and calcaneal BUA values were lower in children in low GMFCS levels than in children in high GMFCS levels (p<0.05; femur BMDa: levels I-III, 0.6-0.7g ⁄ cm 2 ; levels IV-V, 0.5g ⁄ cm 2 ; calcaneal BUA: levels I-II, 39db ⁄ MHz; levels III-V, 20-21db ⁄ MHz). Lumbar BMDa and most bone markers did not differ significantly among CP and healthy groups. Regression analysis revealed that growth variables and GMFCS level were mainly associated with lower limb BMDa and BUA, and growth variables were mainly associated with lumbar BMDa (adjusted r 2 =0.48-0.56). None of the bone markers were associated with bone density.INTERPRETATION Bone densities vary and are associated with a number of factors in different skeletal regions in children with CP with a range of motor severities.

Osteonecrosis (ON) is a potentially disabling complication encountered in children who receive chemotherapy for acute lymphoblastic leukemia (ALL). Considering the possible effect of ethnic difference on the clinical features of symptomatic ON in pediatric ALL, we retrospectively evaluated 245 children with ALL who were treated at Chang Gung Memorial Hospital, Linkou, between 2002 and 2011. Six (2.4 %) patients developed symptomatic ON in a total of 17 sites during the follow-up period. Diagnosis of ON was confirmed by X-ray in seven, magnetic resonance imaging in two, and bone scan in three patients. The estimated cumulative incidence of symptomatic ON in newly diagnosed ALL was 3.4 % at 8 years. Four patients received ON-directed surgical interventions, including total hip replacement in three and arthroplasty in one. The incidence of ON was significantly higher among girls (P = 0.03), patients >10 years old (P = 2.2 × 10(-4)), and patients who had received more intensive chemotherapy regimen (P = 0.02). These results indicate that the incidence and risk factors in our institute were similar to those observed in Western countries. Future studies surveying the impact on the quality of life of childhood ALL survivors in Taiwan are warranted.