Impaired Bone Growth and Mineral Density in Children with Cerebral Palsy: Can It Be Corrected?
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.
KeywordsBone Mineral Density Growth Hormone Fracture Risk Cerebral Palsy Growth Hormone Deficiency
Bone mineral density
Dual-energy X-ray absorptiometry
Insulin-like growth factor
Insulin-like growth factor binding protein
Magnetic resonance imaging
Quantitative computerized tomography
- Henderson RC, Berglund LM, May R, Zemel BS, Grossberg RI, Johnson J, Plotkin H, Stevenson RD, Szalay E, Wong B, Kecskemethy HH, Harcke HT. 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 Mineral Res. 1997;0:1–30.Google Scholar
- O’Donnell S, Cranney A, Wells GA, Adachi JD, Reginster JY. Strontium ranelate for preventing and treating postmenopausal osteoporosis. Cochrane Database Syst Rev. 2006;CD005326.Google Scholar
- Panigrahi I, Das RR, Sharda S, Marwaha RK, Khandelwal NJ. Response to zolendronic acid in children with type III osteogenesis imperfecta. Bone Miner Metab. 2010 Jul;28(4):451–5. Epub 2010 Feb 4.Google Scholar
- Rauch F, Travers R, Glorieux FH Pamidronate in children with osteogenesis imperfecta: histomorphometric effects of long-term therapy. J Clin Endocrinol Metab. 2006 Feb;91(2):511–6. Epub 2005 Nov 15.Google Scholar