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Scanning Skeletal Remains for Bone Mineral Density in Forensic Contexts
Published on: January 29, 2018
How to identify children with cerebral palsy at risk of low bone mineral density
Marianne Lindblad Pedersen1, Johan Sebastian Ohlendorf2, Thomas Alexander Gerds2
1University Hospital Herlev, Department of Pediatrics, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
Insights
Low bone mineral density (BMD) affects 17% of children with cerebral palsy (CP). Key risk factors include higher Gross Motor Function Classification System scores, limited weight-bearing activity, and anti-seizure medications.
Area of Science:
- Pediatric Orthopedics
- Pediatric Neurology
- Pediatric Endocrinology
Background:
- Cerebral palsy (CP) is a prevalent chronic condition causing motor disabilities in children.
- Low bone mineral density (BMD) is a significant concern in children with CP, potentially increasing fracture risk.
- Understanding the prevalence and risk factors for low BMD in this population is crucial for effective management.
Purpose of the Study:
- To determine the prevalence of low bone mineral density (BMD) in children diagnosed with cerebral palsy (CP).
- To investigate the association between BMD and various risk factors in children with CP.
- To identify specific factors contributing to reduced bone health in pediatric CP patients.
Main Methods:
- A cross-sectional study was conducted involving children with cerebral palsy.
- Data collection included Dual X-ray Absorptiometry (DXA) for BMD assessment, blood tests, clinical examinations (including Tanner stage), anthropometric measurements, and physical activity evaluation.
- Participants' Gross Motor Function Classification System (GMFCS) scores were analyzed in relation to BMD.
Main Results:
- The study included 81 children with CP, aged 2.1-17.4 years (median 9 years).
- A mean BMD z-score of -0.2 was observed, with 17% of participants exhibiting low BMD.
- Higher GMFCS scores (p < 0.01), less than 30 minutes of daily weight-bearing activity (p = 0.01), and use of anti-seizure medication (p = 0.02) were significantly associated with lower BMD.
Conclusions:
- Approximately 17% of children with cerebral palsy have low bone mineral density, irrespective of motor impairment severity.
- Gross Motor Function Classification System scores, limited weight-bearing physical activity, and anti-seizure medication use are negatively associated with BMD in children with CP.
- Serum vitamin D levels, sex, BMI, and pubertal status were not found to be significantly associated with BMD in this cohort.
Aim:
Cerebral palsy is a common chronic motorically disabling condition in children. The aim of this study was to determine prevalence of low bone mineral density (BMD) in children with cerebral palsy and to examine the association between BMD with risk factors.
Methods:
Cross sectional study of children with cerebral palsy analyzing Dual X-ray Absorptiometry, blood tests, full clinical medical examination including Tanner stage and nutritional status, measurement of anthropometrics and assessment of physical activity.
Results:
The 81 participants were aged 2.1-17.4 years (median 9 years) and 64 out of 81 had a mild cerebral palsy (Gross Motor Function Classification System score of I-II). Mean BMD z-score was -0.2 (SD = 1.05, range -4.6 to 2.0). GMFCS score was negatively associated with BMD (p < 0.01) as higher score led to 1.43 SD lower BMD [-1.97 to -0.89]. Weight bearing activity was negatively associated with lower BMD z-score (p = 0.01), as having <30 min of weight bearing activity per day lead to 0.98 SD lower BMD [-1.75; -0.22]. Use of anti-seizure medication was negatively associated with BMD (BMD z-score 0.7 SD lower; p = 0.02, [-1.28; -0.12]). Serum vitamin D levels or fracture rates were not statistically significantly associated with BMD changes.
Conclusion:
We found 17 % of children have low BMD regardless of motoric impairment level. GMFCS score, Sparse weight bearing activity and use of anti-seizure medicine were negatively associated to BMD. No significant associations were found with vitamin D, sex, BMI, puberty.
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