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Erschienen in:
01.12.2020 | Original Article
Bone health impairment in patients with cerebral palsy
Erschienen in: Archives of Osteoporosis | Ausgabe 1/2020
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Summary
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.