ESPE Abstracts

Introduction Up to 75% of Cerebral palsy(CP) children are of spastic diplegic & quadriplegic types with severe malnutrition found in 35% of them which is multifactorial. Motor impairment is strongly corelated with Gross Motor Function Classification(GMFCS) level 3 and above, malnutrition, and low bone mineral density(BMD) assessed via dual energy x-ray absorptiometry(DXA) scan. These children have low age adjusted BMD z scores <-2SD subsequently increasing their fracture risk.

Objective To evaluate the effect of motor impairment and nutritional status on Bone mineral density(BMD) in children with spastic diplegic and quadriplegic Cerebral Palsy(CP).

Methods: It was a prospective cohort study, done at the pediatric neurology clinic of Aga Khan University Hospital Karachi, Pakistan, from June to December 2022 with a sample size of 52 children. This was a funded study. Spastic diplegic and quadriplegic CP children with GMFCS (3 and above) between 3-18 years of age were included in study. A detailed nutritional evaluation was done using anthropometric measurement with weight & height/length for age on CP specific growth charts. Bone mineral density z-score was measured at lumbar spine, left hip, femur &left distal forearm with DXA scan. Z score value of <-2.0 SD was taken as low BMD indicating high risk of fracture. Mean and standard deviations were calculated for age, weight, height/length, BMI and BMD z-score. Chi square test was applied, P<0.05 was considered statistically significant between severely malnourished and BMD.

Results: Out of 52 children, 18 were spastic quadriplegic and 34 spastic diplegic CP.29% of them classified as GMFCS class 4 & 5 and 71 % GMFCS class 3. All the children had weight, height/length and BMI <5th percentile. Mean Bone mineral content according to DXA scans was reported -5.2 ±2.1SD on femur neck & -4.2±1.8SD on spine in spastic quadriplegic children. Whereas it was -4.2±1.6SD & -3.5±1.5SD on femur neck and spine respectively in spastic diplegic children. There was no statistical significance between age and gender however, BMI, motor impairment, fracture history, and pattern of CP had a significant impact on BMD and Z-score values of these children.2 of the spastic quadriplegic children had history of femur fractures.

Conclusion: Our study highlights that low BMD is prevalent in children with moderate to severe CP especially those who were nonambulatory which is inturn associated with significant fracture risk. Early identification can lead to damage prevention, appropriate management including bone health optimization and bisphosphonates to prevent occurrence of further fractures, thus contributing to improved quality of life.