Impaired Bone Growth and Mineral Density in Children with Cerebral Palsy: Can It Be Corrected?

  • Omar Ali


Children with cerebral palsy have an increased risk of osteoporosis and osteopenia due to multiple factors, including limited weight bearing, decreased muscle strength, immobilization, malnutrition, rickets of prematurity, use of anti-convulsant medications, and deficiencies of growth hormone and sex hormones. Children with CP have an increased risk of fractures, especially of the distal femur. The relationship between osteopenia and fracture risk is not as well defined as it is in adults but fracture risk does increase with decreasing bone mineral density. Preventive measures include maximal weight bearing, vibration therapy, adequate nutrition (especially calcium and vitamin D intake), and treatment of growth hormone and sex hormone deficiency. DXA scanning is the most commonly used method for evaluation of BMD, but other methods are also available. Thresholds for treatment are not well defined but treatment is indicated in patients with osteoporosis and a history of significant fractures. Proposed interventions include adequate nutrition, increased weight bearing, exercise, calcium, vitamin D, vitamin K, growth hormone, and bisphosphonates. Bisphosphonates are the most effective treatments, but there is no consensus regarding treatment thresholds, dose, frequency, and choice of agent. Pamidronate and alendronate are the most commonly used agents, but it is likely that all bisphosphonates are similar in efficacy. Adverse effects are uncommon but need to be kept in mind. Further research is needed to clarify optimal screening and treatment protocols.


Bone Mineral Density Growth Hormone Fracture Risk Cerebral Palsy Growth Hormone Deficiency 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Bone mineral density


Cerebral palsy


Dual-energy X-ray absorptiometry


Insulin-like growth factor


Insulin-like growth factor binding protein


Magnetic resonance imaging


Quantitative computerized tomography


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Medical College of WisconsinMilwaukeeUSA

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