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Longitudinal changes in bone density in children and adolescents with moderate to severe cerebral palsy
Richard C Henderson1, John A Kairalla, John W Barrington
1Department of Orthopaedics and Biostatistics, University of North Carolina, NC 27599, USA. rchh@med.unc.edu
Insights
Children with cerebral palsy (CP) experience diminished bone mineral density (BMD) growth, leading to osteopenia. This study tracked BMD changes in pediatric CP patients, revealing age-related declines despite some growth.
Area of Science:
- Pediatric Endocrinology
- Orthopedics
- Neurology
Background:
- Children and adolescents with moderate to severe cerebral palsy (CP) often exhibit impaired bone health.
- Understanding the natural history of bone mineral density (BMD) in this population is crucial for managing complications like osteopenia and fractures.
Purpose of the Study:
- To prospectively evaluate the longitudinal changes in bone mineral density (BMD) in children and adolescents diagnosed with moderate to severe cerebral palsy (CP).
- To identify factors associated with BMD variations and growth patterns in this specific pediatric cohort.
Main Methods:
- A prospective, longitudinal observational study involving 69 participants with moderate to severe spastic CP, aged 2.0 to 17.7 years.
- Regular assessments included bone mineral density (BMD) measurements, growth parameters, nutritional status, Tanner stage, and clinical CP features.
- Extended follow-up periods of over 2 and 3 years for a significant proportion of the subjects.
Main Results:
- Initial lower BMD z-scores correlated with increased CP severity (motor function, feeding difficulties) and poorer growth indicators (weight z-scores).
- Average annual BMD increases of 2%–5% were observed in the distal femur and lumbar spine, with wide individual variability (-31% to +42%).
- Despite overall increases, distal femur BMD z-scores showed a decrease with advancing age in the study population.
Conclusions:
- Children with severe CP are at high risk of developing clinically significant osteopenia due to a reduced rate of bone mineral accrual compared to healthy peers.
- This bone loss is characterized by diminished growth rather than net bone mineral loss, differentiating it from osteoporosis in elderly adults.
- Accurate assessment of interventions aimed at increasing BMD requires a baseline understanding of the expected natural changes in BMD within this CP population.
Objective:
To assess the natural history of "growth" in bone mineral density (BMD) in children and adolescents with moderate to severe cerebral palsy (CP).
Study Design:
A prospective, longitudinal, observational study of BMD in 69 subjects with moderate to severe spastic CP ages 2.0 to 17.7 years. Fifty-five subjects were observed for more than 2 years and 40 subjects for more than 3 years. Each evaluation also included assessments of growth, nutritional status, Tanner stage, general health, and various clinical features of CP.
Results:
Lower BMD z-scores at the initial evaluation were associated with greater severity of CP as judged by gross motor function and feeding difficulty, and with poorer growth and nutrition as judged by weight z-scores. BMD increased an average of 2% to 5%/y in the distal femur and lumbar spine, but ranged widely from +42%/y to -31%. In spite of increases in BMD, distal femur BMD z-scores decrease with age in this population.
Conclusions:
Children with severe CP develop over the course of their lives clinically significant osteopenia. Unlike elderly adults, this is not primarily from true losses in bone mineral, but from a rate of growth in bone mineral that is diminished relative to healthy children. The efficacy of interventions to increase BMD can truly be assessed only with a clear understanding of the expected changes in BMD without intervention.
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