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Assessment and management of low bone mineral density in children with cerebral palsy
Leslie N Rhodes1,2, Alicia Diaz-Thomas1,2, Woodi H Woodland1
1University of Tennessee Health Science Center, Memphis, TN, USA.
Insights
Children with cerebral palsy (CP) often experience decreased bone mineral density (BMD). This study outlines an algorithm to identify at-risk children and summarizes assessment and treatment strategies for low BMD in CP.
Area of Science:
- Pediatrics
- Neurology
- Orthopedics
Background:
- Cerebral palsy (CP) affects motor function and coordination due to early brain injury.
- Decreased bone mineral density (BMD) is a common comorbidity in children with CP.
- Early identification and management of low BMD are crucial for bone health.
Purpose of the Study:
- To present an algorithm for identifying children with CP at risk for decreased BMD.
- To review current assessment methods for BMD in pediatric CP patients.
- To summarize treatment options for increasing BMD in children with CP.
Main Methods:
- An algorithm incorporating medication history, fracture history, diet, ambulation, endocrinopathy, and pubertal stage was developed.
- Dual-energy x-ray absorptiometry (DXA) scans are used to measure BMD.
- Literature review of current assessment and treatment guidelines.
Main Results:
- The algorithm aids in risk stratification for decreased BMD in CP.
- DXA scans provide quantitative BMD measurements.
- Treatment options include stander use, dietary modifications, and bisphosphonate therapy.
Conclusions:
- A proactive approach using a risk assessment algorithm is recommended for children with CP.
- Regular BMD assessment is essential for early detection of bone density issues.
- Comprehensive management involving physical, nutritional, and pharmacological interventions can improve BMD in children with CP.
Abstract:
Cerebral palsy (CP) is an impairment in motor function and coordination due to a nonprogressive brain injury that occurs pre-, peri-, or postnatally until 2 years of age with a prevalence of 1 to 4 per 1,000 live births. Along with impaired motor function, decreased bone mineral density (BMD) in children with CP is of concern for providers. An algorithm has been created to help identify patients at risk for decreased BMD who are seen by providers. Factors included in the algorithm are medication history, fracture history, ketogenic diet, ambulation status, history of endocrinopathy, and pubertal stage.BMD levels are measured using dual-energy x-ray absorptiometry scans. Once a patient is identified as having decreased BMD several treatment options are available. BMD can be increased through stander use, diet, and bisphosphonate treatment. This paper serves as a summary of the current ways in which children with CP are assessed at each visit, as well as how to treat low BMD once it has been identified.
Key Concepts:
(1)Explain the algorithm used to identify patients at risk for decreased BMD.(2)Review how to assess patients with decreased BMD.(3)Summarize treatment recommendations to increase BMD in children with CP.
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