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Motor impairment and skeletal mineralization in children with cerebral palsy
Noreen Akhter1, Atif Ahmed Khan2, Aisha Ayyub3
1Combined Military Hospital, Abbottabad.
Insights
Children with cerebral palsy (CP) have low bone mineral density, particularly those with moderate to severe motor impairment. This study highlights the impact of motor function on bone health in pediatric CP.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Bone Metabolism
Background:
- Cerebral palsy (CP) is a common neurodevelopmental disorder affecting motor function.
- Bone mineral density (BMD) is crucial for skeletal health and fracture prevention.
- Understanding factors influencing BMD in children with CP is essential for clinical management.
Purpose of the Study:
- To assess bone mineral density (BMD) in children with cerebral palsy (CP).
- To investigate the relationship between the severity of motor impairment and BMD in pediatric CP.
- To evaluate the effect of Gross Motor Function Classification System (GMFCS) levels on BMD.
Main Methods:
- A cross-sectional study involving 86 children diagnosed with cerebral palsy.
- Children were categorized into mild (GMFCS levels 1-2) and moderate to severe (GMFCS levels 3-5) motor impairment groups.
- Bone mineral density z-scores were measured at the lumbar spine (L1-L4) using Dual Energy X-ray Absorptiometry (DXA).
Main Results:
- The mean bone mineral density z-score for all participants was -2.16 ± 0.62.
- A statistically significant difference in BMD z-scores was observed between the moderate to severe CP group and the mild CP group (p<0.05).
- BMD z-scores varied significantly across different GMFCS levels, indicating a correlation between motor impairment severity and bone health.
Conclusions:
- Children with cerebral palsy exhibit low bone mineral density (BMD) z-scores.
- Non-ambulatory children and those with more severe motor impairment (higher GMFCS levels) are at higher risk for reduced BMD.
- These findings underscore the importance of monitoring BMD in pediatric CP populations, especially those with significant motor deficits.
Objective:
To evaluate the bone mineral density and the effect of motor impairment on bone mineral density in children with cerebral palsy.
Methods:
The cross-sectional study was conducted at the Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan, from January 2013 to January 2015. Children diagnosed with cerebral palsy were sampled by non-probability purposive sampling from the Cerebral Palsy clinic. On the basis of Gross Motor Function Classification level of motor impairment, the children were divided into mild Cerebral Palsy (level 1 & 2) and moderate to severe Cerebral Palsy (level 3-5) groups. Bone mineral density z-score was measured at lumbar spine with Dual Energy X-Ray Absorptiometry at L1-L4 lumbar vertebra. Data was analysed using SPSS 20.
Results:
Of the total 108 children selected, 18(16.6%) had to be excluded due to poor nutrition status or deranged serum chemistry, while in 4(3.7%) children Dual Energy X-ray Absorptiometry scan was not done on technical grounds. Of the remaining 86(79.6%) children, 39(45.3%) were males and 47(54.7%) were females. The overall mean age was 6.08±2.89 years and mean bone mineral density z-score was -2.16±0.62. Statistically significant difference was found in bone mineral density z-scores of moderate to severe compared to mild Cerebral Palsy group (p<0.05). Significant difference in bone mineral density z-scores was also found among different levels of Gross Motor Function Classification system of motor impairment (p<0.05).
Conclusions:
Cerebral Palsy children had low bone mineral density z-score, especially those who were non-ambulatory.
