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Bone density and size in ambulatory children with cerebral palsy
Tishya Al Wren1, David C Lee, Robert M Kay
1Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. twren@chla.usc.edu
Insights
Children with cerebral palsy (CP) may have reduced bone density in their tibias, with more severe functional limitations (Gross Motor Function Classification System [GMFCS] levels) correlating with smaller bone size. Spine deficits were more pronounced in children with higher GMFCS levels.
Area of Science:
- Pediatric Orthopedics
- Bone Biology
- Neuromuscular Disorders
Background:
- Cerebral palsy (CP) affects bone development and strength.
- Understanding bone properties in relation to functional level is crucial for long-term health.
Purpose of the Study:
- To investigate the relationship between axial and appendicular bone characteristics and functional status (GMFCS level) in ambulatory children with CP.
Main Methods:
- Quantitative computed tomography (QCT) was used to assess bone properties.
- 37 children with CP and 37 controls were compared.
- Linear regression analyzed volumetric bone density (vBMD) and geometric properties of the L3 vertebra and tibia, adjusting for covariates.
Main Results:
- Vertebral size was smaller in children with CP, particularly those in GMFCS levels III and IV, but vBMD did not differ.
- Tibia bone size and volumetric density decreased with increasing GMFCS level.
- GMFCS level impacted bone size more in females than males.
Conclusions:
- Children with CP may exhibit reduced tibial bone mass across all functional levels.
- Spinal bone deficits are more evident in children with higher GMFCS levels.
- Early assessment of bone acquisition in children with CP is vital to mitigate future osteoporosis risk.
Aim:
To examine the relation of axial and appendicular bone properties in ambulatory children with cerebral palsy (CP) to functional (Gross Motor Function Classification System [GMFCS]) level.
Method:
Quantitative computed tomography measurements were compared among 37 children with CP (12 children in GMFCS level I, five in level II, 18 in level III, two in level IV; five with hemiplegia, 23 with diplegia, two with triplegia, seven with quadriplegia; mean age 9y 4mo, SD 1y 6mo; 18 males, 19 females) and 37 children in a comparison group (same age and sex distributions). Linear regression was used to evaluate differences in volumetric cancellous bone density (vBMD) and geometric properties of the L3 vertebra and tibia, adjusting for height, weight, and sex as covariates.
Results:
The comparison group had larger vertebrae than the children with CP (p = 0.02) owing to smaller vertebral size in GMFCS levels III and IV, but there was no difference in vertebral vBMD (p = 0.49). In the tibia, bone volumetric density (p = 0.09) and size (p = 0.02) decreased with increasing GMFCS level. GMFCS level had a greater effect on bone size in females than in males (p<0.07).
Interpretation:
Children with CP of all levels may have less bone in their tibias, whereas spine deficits differentially affect more involved children. Because even small bone deficits may manifest as osteoporosis later in life, it is important to study bone acquisition in all children with CP.
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