Archives of Osteoporosis

, 13:17 | Cite as

Bone mineral density and nutritional status in children with quadriplegic cerebral palsy

  • Citlalli Alvarez Zaragoza
  • Edgar Manuel Vasquez GaribayEmail author
  • Andrea A. García Contreras
  • Alfredo Larrosa Haro
  • Enrique Romero Velarde
  • Alejandro Rea Rosas
  • José Luis Cabrales de Anda
  • Israel Vega Olea
Original Article



This study demonstrated the relationship of low bone mineral density (BMD) with the degree of motor impairment, method of feeding, anthropometric indicators, and malnutrition in children with quadriplegic cerebral palsy (CP). The control of these factors could optimize adequate bone mineralization, avoid the risk of osteoporosis, and would improve the quality of life.


The purpose of the study is to explore the relationship between low BMD and nutritional status in children with quadriplegic CP.


A cross-sectional analytical study included 59 participants aged 6 to 18 years with quadriplegic CP. Weight and height were obtained with alternative measurements, and weight/age, height/age, and BMI/age indexes were estimated. The BMD measurement obtained from the lumbar spine was expressed in grams per square centimeter and Z score (Z). Unpaired Student’s t tests, chi-square tests, odds ratios, Pearson’s correlations, and linear regressions were performed.


The mean of BMD Z score was lower in adolescents than in school-aged children (p = 0.002). Patients with low BMD were at the most affected levels of the Gross Motor Function Classification System (GMFCS). Participants at level V of the GMFCS were more likely to have low BMD than levels III and IV [odds ratio (OR) = 5.8 (confidence interval [CI] 95% 1.4, 24.8), p = 0.010]. There was a higher probability of low BMD in tube-feeding patients [OR = 8.6 (CI 95% 1.0, 73.4), p = 0.023]. The probability of low BMD was higher in malnourished children with weight/age and BMI indices [OR = 11.4 (1.3, 94), p = 0.009] and [OR = 9.4 (CI 95% 1.1, 79.7), p = 0.017], respectively.


There was a significant relationship between low BMD, degree of motor impairment, method of feeding, and malnutrition. Optimizing these factors could reduce the risk of osteopenia and osteoporosis and attain a significant improvement of quality of life in children with quadriplegic CP.


Bone mineral density Cerebral palsy Nutritional status Children 


Compliance with ethical standards

The protocol did not put participants at risk and adhered to the Helsinki Declaration guidelines in its last correction made during the 64th Annual Assembly organized by the World Medical Association (2013). Signature of the informed consent was obtained by the persons legally responsible for the participants, and the research protocol was approved by the Bioethics and Research Committee of the New Civil Hospital of Guadalajara (Registration Number: 66/HCJIM-JAL/2016).

Conflicts of interest


Supplementary material

11657_2018_434_MOESM1_ESM.docx (58 kb)
ESM 1 (DOCX 58 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Citlalli Alvarez Zaragoza
    • 1
  • Edgar Manuel Vasquez Garibay
    • 1
    • 2
    • 3
    Email author
  • Andrea A. García Contreras
    • 1
  • Alfredo Larrosa Haro
    • 1
  • Enrique Romero Velarde
    • 1
    • 2
  • Alejandro Rea Rosas
    • 2
  • José Luis Cabrales de Anda
    • 2
  • Israel Vega Olea
    • 2
  1. 1.Instituto de Nutrición HumanaUniversidad de GuadalajaraGuadalajaraMexico
  2. 2.Nuevo Hospital Civil de GuadalajaraGuadalajaraMexico
  3. 3.Instituto de Nutrición HumanaHospital Civil de Guadalajara Dr. Juan I. “Menchaca”GuadalajaraMexico

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