Children with cerebral palsy have an increased risk of fracture and low bone mass. A systematic review was carried out to identify the associated or risk factors. The role of bone mineral density measurement (particularly whole-body or distal femur) by dual-energy X-ray absorptiometry and quantitative computed tomography is examined. Current strategies to prevent or treat the bone fragility in children with cerebral palsy are summarised.
BlairE.Epidemiology of cerebral palsies. Orthop Clin North Am2010;41:441–55.
2.
KingW, LevinR, SchmidtR, Prevalence of reduced bone mass in children and adults with spastic quadriplegia. Dev Med Child Neurol2003;45:12–6.
3.
PresedoA, DabneyKW, FreemanM.Fractures in patients with cerebral palsy. J Pediatr Orthop2007;27:147–53.
4.
LettAI, MesfinA, PichardC, Fractures in children with cerebral palsy. J Pediatr Orthop2006;26:624–7.
5.
BischofF, BasuD, PettiforJM. Pathological long-bone fractures in residents with cerebral palsy in a long-term care facility in South Africa. Dev Med Child Neurol2002;44:119–22.
6.
StevensonRD, ConawayM, BarringtonJW, Fracture rate in children with cerebral palsy. Pediatr. Rehabil2006;9:396–403.
7.
BajelidzeG, BelthurMV, LittletonAG, Diagnostic evaluation using whole-body technetium bone scan in children with cerebral palsy and pain. J Pediatr Orthop2008;28:112–7.
8.
HoST, HuiYCN. Fractures in non-ambulatory cerebral palsy children. Hong Kong J Orthop Surg2006;10. S56.
9.
HendersonRC, LarkKK, GurkaJM, Bone density and metabolism in children and adolescents with moderate to severe cerebral palsy. Pediatrician2002;110:439–43.
10.
HendersonRC. Bone density and other possible predictors of fracture risk in children and adolescents with spastic cerebral palsy. Dev Med Child Neurol1997;39:224–7.
11.
SturmPF, AlmanBA, ChristieBL. Femur fractures in institutionalized patients after hip spica immobilization. J Pediatr Orthop1993;13:246–8.
12.
StasikelisPJ, LeeDD, SullivanCM. Complications of osteotomies in severe cerebral palsy. J Pediatr Orthop1999;19:207–16.
13.
SzalayEA, HarrimanD, EastlundB, Quantifying postoperative bone loss in children. J Pediatr Orthop2008;28:320–3.
14.
Samson-FungL, FungE, StallingsVA, Relationship of nutritional status to health and societal participation in children with cerebral palsy. J Pediatr2002;141:637–43.
15.
KoCH, TsePWT, ChanAKH. Risk factors of long bone fracture in non-ambulatory cerebral palsy children. Hong Kong Med J2006;12:426–31.
16.
ChanHSS, LauPHB, FongKH, Neuro-impairment, activity limitation, and participation restriction among children with cerebral palsy in Hong Kong. Hong Kong Med J2005;11:342–50.
17.
TolmanKG, JubizW, SannellaJJ, Osteomalacia associated with anticonvulsant drug therapy in mentally retarded children. Pediatrician1975;56:45–50.
18.
RauchR, PlotkinH, DiMeglioL, Fracture prediction and the definition of osteoporosis in children and adolescents: the ISCD 2007 pediatric official position. J Clin Densitom2007;11: 22–8.
19.
HendersonRC, KairallaJA, BarringtonJW, Longitudinal changes in bone density in children and adolescents with moderate to severe cerebral palsy. J Pediatr2005;146:769–75.
20.
HendersonRC, LinPP, GreeneWB. Bone-mineral density in children and adolescents who have spastic cerebral palsy. J Bone Joint Surg Am1995;77A: 1671–81.
21.
BabayigitA, DirikE, BoberE, Adverse effects of antiepileptic drugs on bone mineral density. Pediatr Neurol2006;35:177–81.
22.
HendersonRC, KairallaJ, AbbasA, Predicting low bone mineral density in children and young adults with quadriplegic cerebral palsy. Dev Med Child Neurol2004;46:416–9.
23.
ClarkEM, NessAR, BishopNG, Association between bone mass and fractures in children: a prospective cohort study. J Bone Miner Res2006;21:1489–95.
24.
FlynnJ, FoleyS, JonesG.Can BMD assessed by DXA at age 8 predict fracture risk in boys and girls during puberty?: an eight-year prospective study. J Bone Miner Res2007;22:1463–7.
25.
KhouryDJ, SzalayEA. Bone mineral density correlation with fractures in non-ambulatory pediatric patients. J Pediatr Orthop2007;27:562–6.
26.
HendersonRC, BerglundLM, MayR, The relationship between fractures and DXA measures of BMD in the distal femur of children and adolescents with cerebral palsy or muscular dystrophy. J Bone Miner Res2010;25:520–6.
27.
KleinGL, BachrachLK, HolmIA. Effects of pharmacologic agents on bone in childhood: an editorial overview. Pediatr2007;119:S125–30.
28.
WrenTAL, LiuXD, PitukcheewanontP, GilzanzV.Bone acquisition in healthy children and adolescents: comparisons of dual-energy x-ray absorptiometry and computed tomography measures. J Clin Endocrinol Metab2005;90:1925–8.
29.
HendersonRC, GilbertSR, ClementME, Altered skeletal maturation in moderate to severe cerebral palsy. Dev Med Child Neurol2005;47:229–36.
30.
TaylorA, KonradPT, NormanME, Total body bone mineral density in young children: influence of head bone mineral density. J Bone Miner Res1997;12:652–5.
31.
LeonardMB, ShultsJ, ZemelBS. DEXA estimates of vertebral volumetric bone mineral density in children: potential advantages of paired posterioanterior and lateral scans. J Clin Densitom2006;9:265–73.
32.
LeonardCM, RozaMA, BarrRD, Reproducibility of DXA measurements of bone mineral density and body composition in children. Pediatr Radiol2009;39:148–54.
33.
HendersonRC, LarkRK, RennerRK, Dual X-ray absorptiometry assessment of body composition in children with altered body posture. J Clin Densitom2001;4:325–35.
ZemelBS, StallingsVA, LeonardMB, Revised pediatric reference data for the distal lateral femur measured by hologic discovery/Delphi dual-energy x-ray absorptiometry. J Clin Densitom2009;12:207–18.
36.
AshbyR, WardKA, RobertsAS, A reference database for the Stratec XCT-2000 peripheral quantitative computed tomography scanner in healthy children and young adults aged 6-19 years. Osteoporos Int2009;20:1337–46.
37.
LeeDC, GilsanzV, WrenTAL. Limitations of peripheral quantitative computed tomography metaphyseal bone density measurements. J Clin Endocrinol Metab2007;92:4248–53.
38.
ChadK, BaileyD, McKayH, The effect of a weight-bearing physical activity program on bone mineral content and estimated volumetric density in children with spastic cerebral palsy. J Pediatr1999;135:115–7.
39.
CaultonJM, WardKA, AlsopCW, A randomized controlled trial of standing program on bone mineral density in non-ambulant children with cerebral palsy. Arch Dis Child2004;89:131–5.
40.
WrenTA, LeeDC, HaraR, Effect of high-frequency, low-magnitude vibration on bone and muscle in children with cerebral palsy. J Pediatr Orthop2010;30:732–8.
41.
RuckJ, ChabotG, RauchF.Vibration treatment in cerebral palsy: a randomized control pilot study. J Musculoskelet Neuronal Interact2010;10:77–83.
42.
SlatkovskaL, AlibhaiSM, BeyeneJ, Effect of whole-body vibration on BMD: a systematic review and meta-analysis. Osteoporos Int2010;21:1969–80.
43.
YamWK, YangHL, AbdullahV, ChanCY. Management of drooling of children with neurological problem in Hong Kong. Brain Dev2006;28:24–9.
44.
PackAM. Treatment of epilepsy to optimize bone health. Curr Treat Options Neurol2011;13:346–54.
45.
Jekovec-VrhovsekM, KocijancicA, PrezeljJ.Effect of vitamin D and calcium on bone mineral density in children with CP and epilepsy in full-time care. Dev Med Child Neurol2000;42:403–5.
AliO, ShimM, FowlerE, Growth hormone therapy improves bone mineral density in children with cerebral palsy: a preliminary pilot study. J Clin Endocrinol Metab2007;92:932–7.
48.
HendersonRC, LarkRK, KeeskemethyHH, Bisphosphonates to treat osteopenia in children with quadriplegic cerebral palsy: a randomized placebo-controlled clinical trial. J Pediatr2002;141:644–51.
49.
GrissomLE, KecskemethyHH, BacrachSJ, Harcke. Bone densitometry in pediatric patients treated with pamidronate. Pediatr Radiol2005;35:511–7.
50.
BacharchSJ, KecskemethyHH, HarckeHT, Pamidronate treatment and posttreatment bone density in children with spastic quadriplegic cerebral palsy. J Clin Densitom2006;9:167–74.
51.
PlotkinH, CoughlinS, KreikemeierR, HeldtK, BruzoniM, LernerG.Low doses of pamidronate to treat osteopenia in children with severe cerebral palsy: a pilot study. Dev Med Child Neurol2006;48:709–12.
52.
BachrachSJ, KecskemethyHH, HarckeHT, HossainJ.Decreased fracture incidence after 1 year of pamidronate treatment in children with spastic quadriplegic cerebral palsy. Dev Med Child Neurol2010;52:837–42.
