Cerebral palsy and bisphosphonates – and what can be learned from other types of secondary osteoporosis in children: A scoping review

Abstract

Aim:We aimed to improve bone health management of children with cerebral palsy (CP) by reviewing studies investigating bisphosphonate therapy in children with CP and other types of secondary osteoporosis. Methods:We included trials on bisphosphonate treatment reporting any direct bone measurement or fracture outcome. All studies of patients with CP were included.We also included all controlled trials of children with secondary bone fragility as well as observational studies with ≥20 participants or at least 3 years of follow-up.Studies were assessed according to PRISMA guidelines using the RoB2-tool and the Newcastle-Ottawa Scale. Results:We reviewed 1104 studies and found 37 eligible. Some studies were sufficiently homogeneous to include in a meta-analysis, and we found a 1-year effect on lumbar spine bone mineral density (BMD) Z-score of +0.65 after oral and + 1.21 after intravenous bisphosphonates in children with secondary osteoporosis. Further, data on adverse events and post-treatment follow-up were reviewed. Limitations were heterogeneity and small size of the included studies. Conclusion:Meta-analysis consistently showed significant BMD increases with bisphosphonates in children with secondary osteoporosis. Direct evidence of the effect of bisphosphonates on reducing fractures is lacking. We found no reports of longterm adverse events yet longer studies are needed.

Levodopa‐refractory hyperprolactinemia and pituitary findings in inherited disorders of biogenic amine metabolism

“…Low bone mineral density is a known complication of hypogonadism, 4 but individuals on phenylalanine‐restricted diet or those with neurological impairment may have low bone mineral density due to nutritional insufficiencies or poor mobility 27,28 . Due to the fact that our patient cohort could have low bone mineral density due to multiple factors, low bone mineral density, osteoporosis, or fractures were not considered as hyperprolactinemia‐related findings.…”

“…26 Low bone mineral density is a known complication of hypogonadism, 4 but individuals on phenylalaninerestricted diet or those with neurological impairment may have low bone mineral density due to nutritional insufficiencies or poor mobility. 27,28 Due to the fact that our patient cohort could have low bone mineral density due to multiple factors, low bone mineral density, osteoporosis, or fractures were not considered as hyperprolactinemiarelated findings. Since pituitary hormone deficiencies (e.g., growth hormone deficiency) are multifactorial, 29 they were regarded to be related to hyperprolactinemia only if there was a significant mass effect of a macroprolactinoma.…”