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Bone health impairment in patients with cerebral palsy
José Miguel Martínez de Zabarte Fernández1,2, Ignacio Ros Arnal3, José Luis Peña Segura4
1Paediatric Service, Obispo Polanco Hospital, Teruel, Spain. chemi87@hormail.com.
Insights
Pediatric patients with cerebral palsy (CP) often have poor bone health and nutritional deficits, increasing fracture risk. Low bone mineral density (BMD) and fat mass are linked to vertebral fractures in children with CP.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Nutritional Science
Background:
- Cerebral palsy (CP) is a leading cause of motor disability in children.
- Bone health issues, including low bone mineral density (BMD) and vertebral fractures, are prevalent in pediatric CP patients.
- Nutritional deficits, particularly low fat mass, may contribute to compromised bone health.
Purpose of the Study:
- To investigate the bone health status of pediatric patients diagnosed with cerebral palsy.
- To explore the relationship between bone health and the neurological and nutritional status of these patients.
Main Methods:
- A cross-sectional, observational study included 51 pediatric patients (ages 4-5) with CP (Gross Motor Function Classification System grades III-V).
- Methods involved surveys, anthropometric measurements, bioimpedanciometry (BIA), and bone densitometry (DXA).
- Lumbar radiography was performed for patients with low BMD (Z score < -2.0) to detect vertebral fractures.
Main Results:
- Over half (52.9%) of the patients exhibited low BMD, with significantly lower scores in those with higher GMFCS grades (V: -3.1).
- Low bone mineral density was associated with reduced fat mass (p=0.030) and cell mass (p=0.040).
- A 25.9% prevalence of vertebral fractures was observed, increasing with neurological impairment severity.
Conclusions:
- Bone health in pediatric CP patients is significantly impacted by neurological involvement and nutritional status.
- Children with moderate-to-severe CP and low BMD face an elevated risk of fractures.
- Early identification and nutritional support are crucial for managing bone health in this population.
Abstract:
Bone health problems may be related to the nutritional deficit in pediatric patients with cerebral palsy. It is common to find asymptomatic vertebral fractures when they have low bone mineral density. Fat mass deficit could be related to a lower bone mineral density and a higher risk of vertebral fractures.
Objectives:
To study the bone health of patients with CP and its relationship with neurological and nutritional status.
Purpose:
Cerebral palsy (CP) is the most common cause of motor disability in pediatric age.
Methods:
Cross-sectional, observational, descriptive, and analytical study in which patients with CP between 4 and 5 years with Gross Motor Function Classification System (GMFCS) grades III-IV-V were included. It was carried out: survey, anthropometric study, bioimpedanciometry (BIA), and bone densitometry. Patients with low bone mineral density (BMD Z score less than - 2.0) underwent lumbar radiography looking for vertebral fractures to be diagnosed with osteoporosis.
Results:
Total sample: 51 patients (51.0% women). Mean age: 11.0 ± 0.5 years. BMD Z score average: - 2.1 (95% CI - 2.5, - 1.7). BMD Z score according to GMFCS: grade III - 1.6 (- 2.2; - 1.), grade IV - 1.6 (- 2.4; - 0.9), grade V - 3.1 (- 3.9, - 2.2) (p = 0.013). Bone health classification according to the International Society for Clinical Densitometry was: 47.1% normal, 52.9% low BMD. Relationship between low BMD and low fat mass (p = 0.030) and low cell mass (p = 0.040) was found. Prevalence of vertebral fractures in lumbar radiography: 25.9%, increasing as the degree of neurological involvement. Vertebral fractures were found in 5/13 GMFCS grade V, 2/6 GMFCS grade IV, and 0/10 GMFCS grade III.
Conclusions:
Bone health in the pediatric population with CP is compromised in relation to the degree of neurological involvement and nutritional status. Those patients with moderate-severe cerebral palsy and low BMD seem to present an increased risk of fracture.
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