ESPE Abstracts

Introduction: Children with cerebral palsy (CP) has an increased risk of bone fragility, low areal bone mineral density (aBMD) and low trauma fractures leading to increased pain experience, decreased mobility and lower quality of life.

Purpose: The aim of this study was to determine the prevalence of low BMD among children with cerebral palsy in Denmark across the spectrum of gross motor function scale (GMFCS) of I-V and identify possible risk factors of low aBMD.

Methods: A cross sectional study of 81 children and adolescents in the out-patient clinic of Herlev Hospital, Department of pediatrics. Mean age was 8.9 years (2,3- 17,5 years), 64 participants was GMFCS I-II (77%) and hence slightly decreased mobility and 18 was GMFCS III-V (23%) indicating severe decreased mobility. Participants had aBMD evaluated by Dual-energy X-ray absorptiometry scan (DXA-scan) whole body less head (WBLH). Further assessment included bone age, Bone Health Index, anthropometrics, full examination including tanner stage and blood test for biomarkers.

Results: This study interestingly demonstrated that children and adolescents with cerebral palsy has decreased aBMD across all levels of physical mobility. Participants with GMFCS I-II had a BMD z-score of -0.01 and participants with GMFCS III-V a BMD z-score of -1.03 (P= 0.002). Further we found aBMD to be related to level of physical activity (hours of weight bearing activity) (P=0.003), vitamin D level (P=0,005), tube feeding (P<0.001) and being underweight (P=0.003). We found that children who participated in leisure activities had a significantly higher aBMD compared to children who did not regardless of their GMFCS score (P=0.004).

Perspective: This study shows that bone fragility is present even in children with only slightly decreased physical mobility and highlights the importance of predicting children at risk in a clinical setting to prevent development of secondary osteoporosis in a longer term among children with impaired mobility.