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Longitudinal changes in bone density in adolescents and young adults with cerebral palsy: A case for early
Anne Trinh1,2,3, Phillip Wong1,2, Michael C Fahey2,4
1Department of Endocrinology, Monash Health, Melbourne, Victoria, Australia.
Insights
Individuals with cerebral palsy (CP) experience low bone mass but achieve significant bone accrual during adolescence. Bone density is maintained into young adulthood, suggesting early childhood intervention for optimal bone health in CP patients.
Area of Science:
- Orthopedics
- Pediatrics
- Bone Metabolism
Background:
- Cerebral palsy (CP) is a developmental motor disorder impacting movement and posture, often leading to complications like low bone mass.
- Factors such as impaired ambulation, nutritional deficits, and hormonal imbalances contribute to reduced bone mineral density in individuals with CP.
Purpose of the Study:
- To longitudinally assess changes in areal bone mineral density (aBMD) throughout adolescence and young adulthood in individuals with CP.
- To investigate the influence of ambulation status, nutritional intake, and hypogonadism on these longitudinal aBMD changes.
Main Methods:
- A retrospective longitudinal study design was employed.
- Data were collected from 45 individuals with CP who underwent dual-energy X-ray absorptiometry (DXA) scans between 2006 and 2018.
- Analysis included assessment of aBMD changes over time and correlation with functional status (GMFCS).
Main Results:
- Baseline aBMD Z-scores were below -2.0 across all measured sites (lumbar spine, femoral neck, total hip, total body).
- A median annual increase in aBMD of +1.2% to 1.9% was observed overall, with a higher rate of 4% to 8% per year in those under 20 years old.
- Bone mineral density Z-scores remained stable over the study period, although reduced functional status (GMFCS) showed a slight negative association with aBMD progression.
Conclusions:
- Individuals with CP exhibit low bone mass from adolescence, but demonstrate substantial bone accrual during their second decade of life.
- Bone mass is generally maintained into young adulthood, indicating a period of consolidation after adolescent growth.
- Optimizing bone health strategies from early childhood is crucial for individuals with CP to maximize long-term skeletal integrity.
Context:
Cerebral palsy (CP) is a motor disorder affecting movement, muscle tone and posture due to damage to the foetal or infant brain. The subsequent lack of ambulation, nutritional deficiencies, anticonvulsant use and hormonal deficiencies have been implicated in the low bone mass associated with this condition.
Objective:
To assess changes in areal bone mineral density (aBMD) during adolescence and young adulthood in individuals with CP. The effect of ambulation, nutrition, hypogonadism on longitudinal changes in aBMD is also examined.
Design:
Retrospective longitudinal study.
Setting And Participants:
Forty-five subjects with CP who had longitudinal dual-energy X-ray absorptiometry (DXA) scans at a single tertiary hospital between 2006 and 2018.
Results:
Mean age at first DXA was 19.4 years (range: 10-36 years), 57.8% were male and 80% were nonambulatory. The mean Z-scores at baseline were <-2.0 at all sites - lumbar spine (LS), femoral neck (FN), total hip (TH) and total body (TB). The median change in aBMD was +1.2%-1.9% per year in all subjects but in those <20 years of age, the median change was 4%-8% per year. Z-scores across all sites remained stable over time. Reduced functional state as measured by the gross motor functional classification scale (GMFCS) had a small negative effect on aBMD over time.
Conclusion:
In adolescents with CP, low bone mass was evident from the baseline DXA. However, significant bone accrual occurred during the second decade, followed by bone maintenance in young adulthood. Future studies should focus on optimizing bone health from early childhood.
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