Longitudinal changes in bone density in adolescents and young adults with cerebral palsy: A case for early intervention

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Abstract

Context: Cerebral palsy (CP) is a motor disorder affecting movement, muscle tone and posture due to damage to the foetal 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 nonambulatory. 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% per year in all subjects but in those <20 years of age, the median change was 4%-8% per 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 optimizing bone health from early childhood.

Original languageEnglish
Number of pages8
JournalClinical Endocrinology
DOIs
Publication statusAccepted/In press - 27 Jun 2019

Keywords

  • bone density
  • cerebral palsy
  • fracture
  • longitudinal
  • osteoporosis

Cite this

@article{34b2920292ef43e69a77d690b70d9ffe,
title = "Longitudinal changes in bone density in adolescents and young adults with cerebral palsy: A case for early intervention",
abstract = "Context: Cerebral palsy (CP) is a motor disorder affecting movement, muscle tone and posture due to damage to the foetal 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 nonambulatory. 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{\%} per year in all subjects but in those <20 years of age, the median change was 4{\%}-8{\%} per 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 optimizing bone health from early childhood.",
keywords = "bone density, cerebral palsy, fracture, longitudinal, osteoporosis",
author = "Anne Trinh and Phillip Wong and Fahey, {Michael C.} and Justin Brown and Strauss, {Boyd J.} and Ebeling, {Peter R.} and Fuller, {Peter J.} and Frances Milat",
year = "2019",
month = "6",
day = "27",
doi = "10.1111/cen.14052",
language = "English",
journal = "Clinical Endocrinology",
issn = "0300-0664",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Longitudinal changes in bone density in adolescents and young adults with cerebral palsy

T2 - A case for early intervention

AU - Trinh, Anne

AU - Wong, Phillip

AU - Fahey, Michael C.

AU - Brown, Justin

AU - Strauss, Boyd J.

AU - Ebeling, Peter R.

AU - Fuller, Peter J.

AU - Milat, Frances

PY - 2019/6/27

Y1 - 2019/6/27

N2 - Context: Cerebral palsy (CP) is a motor disorder affecting movement, muscle tone and posture due to damage to the foetal 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 nonambulatory. 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% per year in all subjects but in those <20 years of age, the median change was 4%-8% per 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 optimizing bone health from early childhood.

AB - Context: Cerebral palsy (CP) is a motor disorder affecting movement, muscle tone and posture due to damage to the foetal 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 nonambulatory. 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% per year in all subjects but in those <20 years of age, the median change was 4%-8% per 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 optimizing bone health from early childhood.

KW - bone density

KW - cerebral palsy

KW - fracture

KW - longitudinal

KW - osteoporosis

UR - http://www.scopus.com/inward/record.url?scp=85068712553&partnerID=8YFLogxK

U2 - 10.1111/cen.14052

DO - 10.1111/cen.14052

M3 - Article

JO - Clinical Endocrinology

JF - Clinical Endocrinology

SN - 0300-0664

ER -