Bone health in pediatric patients with neurological disorders

Abstract

Patients with neurological disorders are at high risk of developing osteoporosis, as they possess multiple risk factors leading to low bone mineral density. Such factors include inactivity, decreased exposure to sunlight, poor nutrition, and the use of medication or treatment that can cause lower bone mineral density such as antiepileptic drugs, ketogenic diet, and glucocorticoids. In this article, mechanisms involved in altered bone health in children with neurological disorders and management for patients with epilepsy, cerebral palsy, and Duchenne muscular dystrophy regarding bone health are reviewed.

Keywords: Bone; Cerebral palsy; Child; Epilepsy; Neurological disorders; Osteoporosis.

Fig. 1.

Vitamin D, bone metabolism, and alteration in patients with neurological disorders. Boxed phrases refer to factors that can cause osteoporosis in patients with neurological disorders. * CYP450 enzyme-inducing drugs increase the metabolism of vitamin D resulting in decreased serum 25-hydroxyvitamin D level and subsequently decreased serum 1,25-dihydroxyvitamin D (1,25(OH)₂D) level. † Ketogenic diet and other drugs that induce metabolic acidosis cause hypercalciuria in association with calcium loss from bone, resulting in negative calcium balance. Ketogenic diet can also cause inadequate calcium and vitamin D intake. ‡ Such a phenomenon is observed in a setting with normal serum calcium level. In the presence of low serum calcium level, 1,25(OH)₂D induces bone resorption. AEDs, antiepileptic drugs.