Fracture Rates in Children with Cerebral Palsy: A Danish, Nationwide Register-Based Study
Jakob Bie Granild-Jensen1,2, Alma Becic Pedersen2,3, Eskild Bendix Kristiansen3
1Department of Child and Youth, Randers Regional Hospital, Randers, Denmark.
Insights
Children with cerebral palsy (CP) do not have higher fracture rates than peers. However, those with epilepsy and on anti-seizure medication show increased fractures, suggesting a need for bone health optimization in these pediatric groups.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Public Health
Background:
- Fracture rates in children with cerebral palsy (CP) are a concern, but age-specific data and the impact of epilepsy are not well understood.
- This knowledge gap hinders effective bone health interventions for children with CP.
Purpose of the Study:
- To determine age-specific fracture rates in children with CP, comparing those with and without epilepsy.
- To identify risk factors for fractures in this population.
Main Methods:
- Utilized Danish national registers to create cohorts of children with and without CP (born 1997-2007).
- Calculated fracture incidence rates from 1997 to 2016.
- Analyzed associations between CP, epilepsy, medication, and fracture rates.
Main Results:
- Identified 1,451 children with CP and 787,159 controls.
- Overall fracture rates were similar between children with and without CP.
- Male sex, epilepsy, and anti-seizure medication were linked to higher fracture rates, particularly lower extremity fractures in non-ambulant children with CP.
Conclusions:
- No increased fracture risk was found in children with CP overall, but bone fragility is suggested in non-ambulant cases.
- Children with epilepsy on anti-seizure medication demonstrated significantly higher fracture rates.
- Bone health optimization strategies are recommended for children with epilepsy and those with CP, especially non-ambulant individuals.
Background:
In children with cerebral palsy (CP), fracture rates have been reported to be higher than in the general population but age-specific fracture rates have not been directly compared and the effect of comorbid epilepsy needs elucidation. This impairs decision-making regarding bone health interventions.
Aim:
We aimed to establish the age-specific fracture rates in children with CP with and without epilepsy in Denmark.
Materials And Methods:
Data from Danish registers were combined to establish cohorts of children with and without CP born in Denmark from 1997 to 2007. Fracture rates were calculated for 1997-2016.
Results:
We identified 1,451 children with CP and 787,159 without CP. Female/male fracture rates per 1,000 person-years were 23/27 with CP and 23/29 without CP. Male sex, epilepsy and anti-seizure medication, but not the diagnosis of CP or GMFCS-level, were associated with higher fracture rates. Relatively more lower extremity fractures occurred in non-ambulant children with CP.
Interpretation/Conclusion:
We found no increased fracture rates in children with CP when compared to peers; however, fracture locations suggested bone fragility in non-ambulant children. All children with epilepsy and on anti-seizure medication had increased fracture rates. We suggest bone health optimization in these groups.
