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Fracture rate in children with cerebral palsy
Richard D Stevenson1, Mark Conaway, John W Barrington
1Department of Pediatrics, University of Virginia, Charlottesville, VA 22903, USA. rds8z@virginia.edu
Insights
Children with moderate or severe cerebral palsy (CP) experience a high fracture rate. Increased body fat, gastrostomy use, and prior fractures are key risk factors for bone fractures in this population.
Area of Science:
- Pediatrics
- Orthopedics
- Neurology
Background:
- Children with moderate or severe cerebral palsy (CP) exhibit a higher prevalence of fractures compared to the general pediatric population.
- Understanding fracture risk factors is crucial for developing targeted preventive strategies.
Purpose of the Study:
- To determine the prevalence and incidence of fractures in children with moderate or severe CP.
- To identify associated risk factors for fractures in this vulnerable group.
Main Methods:
- A longitudinal study involving 364 children with moderate-to-severe motor impairment (GMFCS III-V).
- Data collected on baseline fracture history and followed over 600 person-years.
- Statistical analysis to identify factors associated with fracture risk.
Main Results:
- 15.5% of children had a history of fractures at baseline.
- The annual fracture rate was 4.0% per child-year.
- Higher body fat, gastrostomy use, and prior fracture history were associated with increased fracture risk.
Conclusions:
- Children with moderate or severe CP are at significant risk for fractures.
- Interventions targeting body fat, gastrostomy use, and fracture history may reduce risk.
- Further research is needed to optimize fracture prevention and treatment in children with CP.
Objectives:
To determine the prevalence of previous fracture, the rate of fracture over time and associated risk factors for fracture in children with moderate or severe cerebral palsy (CP).
Study Design:
Three hundred and sixty-four children with moderate-to-severe motor impairment (Gross Motor Function Classification System III, IV and V) enrolled in a multi-centre, region-based longitudinal study of growth, nutrition and health. Of these, 297 had baseline fracture information and 261 children had at least one follow-up assessment. Median duration of follow-up was 1.6 years, for over 600 person-years of follow-up.
Results:
Forty-six (15.5%) children reported 62 previous fractures at baseline assessment. Children with a history of fractures at baseline were older (mean age 11.9 vs. 8.9 years, p<0.0001) and had greater body fat (triceps z-score -0.01 vs. -0.68, p=0.0003) than children with no previous fracture. Twenty children (6.7%) reported 24 fractures during the follow-up period. Factors associated with risk of fracture during the follow-up period were higher body fat (p=0.03), gastrostomy use (p=0.05) and previous fracture (p=0.10). Based on 24 fractures in 604.5 person-years of follow-up, the rate of fracture was 4.0 per hundred children (4.0%) per year. For children with a history of fracture at baseline, the fracture rate was 7.0% per year; for children with gastrostomy, 6.8% per year; and for children with high triceps skinfold, 9.7% per year.
Conclusions:
Children with moderate or severe CP are at high risk for fracture. Children with greater body fat, feeding gastrostomy and prior history of fracture are at highest risk and may benefit most from intervention. Further longitudinal study and clinical trials in children with CP are needed to better understand the factors contributing to fracture risk in this population and the best methods of prevention and treatment.
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