Underdevelopment of trabecular bone microarchitecture in the distal femur of nonambulatory children with cerebral palsy becomes more pronounced with distance from the growth plate

Modlesky, Christopher M.; Whitney, Daniel G.; Singh, Harshvardhan; Barbe, Mary F.; Kirby, Joshua; Miller, Freeman

doi:10.1007/s00198-014-2873-4

Cited by 42 publications

(27 citation statements)

References 24 publications

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“…Premature birth, poor oromotor function, inadequate nutrition and calcium intake, anticonvulsant use, and nonambulation or immobility are commonly seen among individuals with CP, and are associated with low bone mineral density. Moreover, underdeveloped skeletal muscle can lead to low mechanical loading during development, exacerbating the inadequate accrual of bone mineral and structure . With aging, factors contributing to osteoporosis only get worse.…”

Section: Discussionmentioning

confidence: 99%

Osteoporosis Epidemiology Among Adults With Cerebral Palsy: Findings From Private and Public Administrative Claims Data

2019

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Individuals with cerebral palsy (CP) have an increased risk for the early development of osteoporosis; however, little is known about the epidemiology of osteoporosis for adults with CP, which is vital to inform clinical practice for osteoporosis prevention, treatment, and management. The purpose of this cross‐sectional study was to determine sex‐stratified prevalence of osteoporosis among adults with CP, as compared with adults without CP. Data from 2016 were extracted from Optum Clinformatics Data Mart (private insurance administrative claims data) and a random 20% sample from the fee‐for‐service Medicare (public insurance administrative claims data). Diagnostic codes were used to identify CP and osteoporosis diagnoses. Sex‐stratified prevalence of osteoporosis was compared between adults with and without CP for the following age groups: 18 to 30, 31 to 40, 41 to 50, 51 to 60, 61 to 70, and >70 years of age. The overall prevalence of osteoporosis was 4.8% for adults without CP (n = 8.7 million), 8.4% for privately insured adults with CP (n = 7,348), and 14.3% for publicly insured adults with CP (n = 21,907). Women and men with CP had a higher prevalence of osteoporosis compared with women and men without CP for all age groups. Finally, publicly insured women and men with CP had a higher prevalence of osteoporosis compared with privately insured women and men with CP for all age groups, except for the similar prevalence among the 18‐ to 30‐year age group. These findings suggest that osteoporosis is more prevalent among adults with CP compared with adults without CP. Study findings highlight the need for earlier screening and preventive medical services for osteoporosis management among adults with CP. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research

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Section: Discussionmentioning

confidence: 99%

Osteoporosis Epidemiology Among Adults With Cerebral Palsy: Findings From Private and Public Administrative Claims Data

2019

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“…Nonambulatory children with more severe spastic CP present with low bone mass and underdeveloped bone architecture [2–6], as well as small, weak [7] and qualitatively-compromised musculature, as indicated by a high degree of fat infiltration [8]. It is not surprising that this musculoskeletal phenotype is associated with a high incidence of low-energy fractures, primarily occurring in the lower limbs [9, 10].…”

Section: Introductionmentioning

confidence: 99%

Cortical bone deficit and fat infiltration of bone marrow and skeletal muscle in ambulatory children with mild spastic cerebral palsy

Whitney

Singh

Miller

et al. 2017

Bone

101

122

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Introduction Nonambulatory children with severe cerebral palsy (CP) have an underdeveloped bone architecture, low bone strength and a high degree of fat infiltration in the lower extremity musculature. The present study aims to determine if such a profile exists in ambulatory children with mild CP and if excess fat infiltration extends into the bone marrow. Materials and methods Ambulatory children with mild spastic CP and typically developing children (4 to 11 years; 12/group) were tested. Magnetic resonance imaging was used to estimate cortical, medullary and total bone volume and width, bone strength [i.e., section modulus (Z) and polar moment of inertia (J)], and bone marrow fat concentration in the midtibia, and muscle volume, intermuscular, subfascial, and subcutaneous adipose tissue (AT) volume and intramuscular fat concentration in the midleg. Physical activity monitors worn on the ankle were used to assess physical activity. Results There were no group differences in age, height, body mass, body mass percentile, BMI, BMI percentile or tibia length, but children with CP had lower height percentile (19th vs. 50th percentile) and total physical activity counts (44 %) than controls (both p < 0.05). Children with CP also had lower cortical volume (30 %), cortical width in the posterior (16 %) and medial (32 %) portion of the shaft, total bone width in the medial-lateral direction (15 %), Z in the medial-lateral direction (34 %), J (39 %) and muscle volume (39 %), and higher bone marrow fat concentration (82.1 ± 1.8 % vs. 80.5 ± 1.9 %), subfascial AT volume (3.3 fold) and intramuscular fat concentration (25.0 ± 8.0 % vs. 16.1 ± 3.3 %) than controls (all p < 0.05). When tibia length was statistically controlled, all group differences in bone architecture, bone strength, muscle volume and fat infiltration estimates, except posterior cortical width, were still present (all p < 0.05). Furthermore, a higher intermuscular AT volume in children with CP compared to controls emerged (p < 0.05). Conclusions Ambulatory children with mild CP exhibit an underdeveloped bone architecture and low bone strength in the midtibia and a greater infiltration of fat in the bone marrow and surrounding musculature compared to typically developing children. Whether the deficit in the musculoskeletal system of children with CP is associated with higher chronic disease risk and whether the deficit can be mitigated requires further investigation.

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“…This is important because individuals with CP first manifest skeletal health problems prior to developing CVD risk factors. In addition to their underdeveloped and structurally weak musculoskeletal system, children with CP exhibit excess intramuscular and bone marrow fat infiltration, which is an additional signal for the pathogenesis of CVD . While the relationship between skeletal fragility and CVD can be bidirectional, it is plausible that poor skeletal health development and preservation throughout the lifespan initiates or exacerbates CVD risk among adults with CP.…”

Section: Discussionmentioning

confidence: 99%

Low‐Trauma Fracture Increases 12‐Month Incidence of Cardiovascular Disease for Adults With Cerebral Palsy

Whitney

Prisby

et al. 2019

Journal Orthopaedic Research

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Individuals with cerebral palsy (CP) have poor skeletal and cardiovascular health. However, no studies have examined if skeletal fragility enhances cardiovascular disease (CVD) risk for this population. The purpose of this study was to determine whether adults with CP have higher 12‐month CVD incidence following a low‐trauma fracture compared with adults without CP. Data, from the Optum Clinformatics® Data Mart, were extracted from adults (18+ years) that sustained a low‐trauma fracture between 01/01/2012 and 12/31/2016. The primary outcome measure was incident CVD within 12 months following a low‐trauma fracture. Cox proportional hazards regression models were used to compare 12‐month incident CVD with adjustment for sociodemographics and chronic disease comorbidities. Mean age (SD) at baseline was 54.7 (18.9) for adults with CP (n = 1,025, 43.3% men) and 60.4 (19.7) for adults without CP (n = 460,504, 33.7% men). During the follow‐up, 121 adults with CP (11.8%, mean age [SD] = 63.9 [16.3]) and 45,330 adults without CP (9.8%, mean age [SD] = 74.5 [11.9]) developed CVD. In the fully adjusted model, adults with CP had higher 12‐month post‐fracture CVD incidence (hazard ratio [HR] = 1.63; 95% confidence interval [CI] = 1.37–1.95). When the outcome was stratified by CVD subtype, adults with CP had higher 12‐month post‐fracture incidence of ischemic heart disease (HR = 1.45; 95% CI = 1.09–1.92), heart failure (HR = 1.68; 95% CI = 1.22–2.31), and cerebrovascular disease (HR = 1.96; 95% CI = 1.54–2.50). Study findings suggest that among adults with CP, low‐trauma fracture may enhance 12‐month CVD incidence compared with adults without CP. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:803‐810, 2020

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Underdevelopment of trabecular bone microarchitecture in the distal femur of nonambulatory children with cerebral palsy becomes more pronounced with distance from the growth plate

Abstract: The underdeveloped trabecular bone microarchitecture in the metaphysis of the distal femur in children with CP becomes more pronounced with greater distance from the growth plate. This pattern is most profound in children with the least developed trabecular bone microarchitecture.

Cited by 42 publications

References 24 publications

Osteoporosis Epidemiology Among Adults With Cerebral Palsy: Findings From Private and Public Administrative Claims Data

Osteoporosis Epidemiology Among Adults With Cerebral Palsy: Findings From Private and Public Administrative Claims Data

Cortical bone deficit and fat infiltration of bone marrow and skeletal muscle in ambulatory children with mild spastic cerebral palsy

Low‐Trauma Fracture Increases 12‐Month Incidence of Cardiovascular Disease for Adults With Cerebral Palsy

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