by Anne Trinh, Phillip Wong, Michael C Fahey, Justin Brown, Boyd J Strauss, Peter R Ebeling, Peter J Fuller, Frances Milat viaClinical Endocrinology
Abstract
Context
Cerebral palsy (CP) is a motor disorder affecting movement, muscle tone and posture due to damage to the fetal or infant brain. The subsequent lack of ambulation, nutritional deficiencies, anticonvulsant use and hormonal deficiencies have been implicated in the low bone mass associated with this condition.
Objective
To assess changes in areal bone mineral density (aBMD) during adolescence and young adulthood in individuals with CP. The effect of ambulation, nutrition, hypogonadism on longitudinal changes in aBMD is also examined.
Design
Retrospective longitudinal study.
Setting and participants
Forty‐five subjects with CP who had longitudinal dual‐energy x‐ray absorptiometry (DXA) scans at a single tertiary hospital between 2006 and 2018.
Results
Mean age at first DXA was 19.4 years (range: 10 ‐ 36 years), 57.8% were male and 80% were non‐ambulatory. The mean Z‐scores at baseline were <‐2.0 at all sites ‐ lumbar spine (LS), femoral neck (FN), total hip (TH) and total body (TB). The median change in aBMD was +1.2‐1.9%/year in all subjects but in those <20 years of age, the median change was 4‐8%/year. Z‐scores across all sites remained stable over time. Reduced functional state as measured by the gross motor functional classification scale (GMFCS) had a small negative effect on aBMD over time.
Conclusion
In adolescents with CP, low bone mass was evident from the baseline DXA. However, significant bone accrual occurred during the second decade, followed by bone maintenance in young adulthood. Future studies should focus on optimising bone health from early childhood.
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