Bone mineral density in children with cerebral palsy

Taşdemir, Haydar Ali; Büyükavcı, Mustafa; Akçay, Fatih; Polat, Pınar; Yıldıran, Alişan; Karakelleoğlu, Cahit

doi:10.1046/j.1442-200x.2001.01352.x

Cited by 48 publications

(29 citation statements)

References 12 publications

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“…In this study, all values of bone markers in children with CP were within normal limits. These findings were consistent with most previous studies 8,23 . Previous studies demonstrated that serum calcium and phosphate levels were significantly higher in children with CP than in the control group, 23 although the serum calcium and phosphate levels were within normal limits 23 .…”

Section: Discussionsupporting

confidence: 93%

“…These findings were consistent with most previous studies 8,23 . Previous studies demonstrated that serum calcium and phosphate levels were significantly higher in children with CP than in the control group, 23 although the serum calcium and phosphate levels were within normal limits 23 . A significant elevation of phosphate levels in children with CP may imply higher bone resorption 23 .…”

Section: Discussionsupporting

confidence: 91%

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Factors associated with bone density in different skeletal regions in children with cerebral palsy of various motor severities

Chen

Wang

et al. 2010

Developmental Medicine &Amp; Child Neurology

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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.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 91%

Factors associated with bone density in different skeletal regions in children with cerebral palsy of various motor severities

Chen

Wang

et al. 2010

Developmental Medicine &Amp; Child Neurology

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“…The observed normocalciuria in most GSF supports previous studies that concluded that the hypercalciuria secondary to immobility is likely a transient phenomenon, with urine calcium levels returning to normal after two weeks [1,2]. These data suggest that neither immobility nor hypercalciuria in and of themselves are the major risk factor in the nephrolithiasis seen in GSF.…”

Section: Discussionsupporting

confidence: 85%

Comparative analysis of nephrolithiasis in otherwise healthy versus medically complex gastrostomy fed children

Smith

Basravi

Schlomer³

et al. 2011

Journal of Pediatric Urology

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Stone disease in GSF is multifactorial, and half of our study group had an identifiable risk factor for nephrolithiasis. A recurring pattern of alkaline urine and calcium phosphate stone formation was evident. GSF did not have higher rates of hypercalciuria despite chronic immobilization and markedly lower bone density. An awareness of the potential risk factors identified is mandatory for this vulnerable population.

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“…[8][9][10][11] In a previous cross sectional study 12 we reported that the degree of reduction in calcaneal broadband ultrasound attenuation (related to BMD and bone structure) and vertebral volumetric trabecular BMD were associated with the degree of immobility and non-weight bearing of the subjects. Nutritional factors that contribute to low BMD in these children with CP include low intake of calcium due to feeding and swallowing difficulties 13 14 and increased catabolism of vitamin D in those treated with anticonvulsants.…”

mentioning

confidence: 94%

A randomised controlled trial of standing programme on bone mineral density in non-ambulant children with cerebral palsy

Caulton

Ward²,

Alsop³

et al. 2004

Archives of Disease in Childhood

137

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Background: Severely disabled children with cerebral palsy (CP) are prone to low trauma fractures, which are associated with reduced bone mineral density. Aims: To determine whether participation in 50% longer periods of standing (in either upright or semiprone standing frames) would lead to an increase in the vertebral and proximal tibial volumetric trabecular bone mineral density (vTBMD) of non-ambulant children with CP. Methods: A heterogeneous group of 26 pre-pubertal children with CP (14 boys, 12 girls; age 4.3-10.8 years) participated in this randomised controlled trial. Subjects were matched into pairs using baseline vertebral vTBMD standard deviation scores. Children within the pairs were randomly allocated to either intervention (50% increase in the regular standing duration) or control (no increase in the regular standing duration) groups. Pre-and post-trial vertebral and proximal tibial vTBMD was measured by quantitative computed tomography (QCT). Results: The median standing duration was 80.5% (9.5-102%) and 140.6% (108.7-152.2%) of the baseline standing duration in the control group and intervention group respectively. The mean vertebral vTBMD in the intervention group showed an increase of 8.16 mg/cm 3 representing a 6% mean increase in vertebral vTBMD. No change was observed in the mean proximal tibial vTBMD. Conclusion: A longer period of standing in non-ambulant children with CP improves vertebral but not proximal tibial vTBMD. Such an intervention might reduce the risk of vertebral fractures but is unlikely to reduce the risk of lower limb fractures in children with CP.

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Bone mineral density in children with cerebral palsy

Abstract: The present study showed that BMD was decreased in all children with CP, but to a greater extent in non-ambulant children with CP, and immobilization is the major effective factor on bone mineralization.

Cited by 48 publications

References 12 publications

Factors associated with bone density in different skeletal regions in children with cerebral palsy of various motor severities

Factors associated with bone density in different skeletal regions in children with cerebral palsy of various motor severities

Comparative analysis of nephrolithiasis in otherwise healthy versus medically complex gastrostomy fed children

A randomised controlled trial of standing programme on bone mineral density in non-ambulant children with cerebral palsy

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