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. 2024 Apr 6:7:100060.
doi: 10.1016/j.jposna.2024.100060. eCollection 2024 May.

Assessment and management of low bone mineral density in children with cerebral palsy

Leslie N Rhodes  1   2 , Alicia Diaz-Thomas  1   2 , Woodi H Woodland  1 , Jeffrey R Sawyer  3 , David D Spence  3 , William C Warner Jr  3
Affiliations

Assessment and management of low bone mineral density in children with cerebral palsy

Leslie N Rhodes et al. J Pediatr Soc North Am. .

Abstract

Cerebral palsy (CP) is an impairment in motor function and coordination due to a nonprogressive brain injury that occurs pre-, peri-, or postnatally until 2 years of age with a prevalence of 1 to 4 per 1,000 live births. Along with impaired motor function, decreased bone mineral density (BMD) in children with CP is of concern for providers. An algorithm has been created to help identify patients at risk for decreased BMD who are seen by providers. Factors included in the algorithm are medication history, fracture history, ketogenic diet, ambulation status, history of endocrinopathy, and pubertal stage.BMD levels are measured using dual-energy x-ray absorptiometry scans. Once a patient is identified as having decreased BMD several treatment options are available. BMD can be increased through stander use, diet, and bisphosphonate treatment. This paper serves as a summary of the current ways in which children with CP are assessed at each visit, as well as how to treat low BMD once it has been identified.

Key concepts: (1)Explain the algorithm used to identify patients at risk for decreased BMD.(2)Review how to assess patients with decreased BMD.(3)Summarize treatment recommendations to increase BMD in children with CP.

Keywords: Bone mineral density; Cerebral palsy; Pediatric.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: William C. Warner, MD reports a relationship with Elsevier that includes: consulting or advisory. William C. Warner, MD reports a relationship with Medtronic Sofamor Danek USA Inc that includes: consulting or advisory. William C. Warner, MD reports a relationship with Wolters Kluwer Health Inc that includes: board membership and consulting or advisory. Jeffrey R. Sawyer, MD reports a relationship with Children’s Spine Foundation that includes: board membership. Jeffrey R. Sawyer, MD reports a relationship with DePuy Orthopaedics Inc that includes: speaking and lecture fees. Jeffrey R. Sawyer, MD reports a relationship with Elsevier Inc that includes: consulting or advisory. Jeffrey R. Sawyer, MD reports a relationship with OrthoPediatrics that includes: consulting or advisory. Jeffrey R. Sawyer, MD reports a relationship with Pediatric Orthopaedic Society of North America that includes: board membership. David D. Spence, MD reports a relationship with Elsevier Inc that includes: consulting or advisory. David D. Spence, MD reports a relationship with OrthoPediatrics that includes: funding grants. David D. Spence, MD reports a relationship with Pediatric Orthopaedic Society of North America that includes: board membership. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1
Algorithm created for determining the risk of low bone mineral density.
Figure 2
Figure 2
DXA image of the lumbar spine.
See this image and copyright information in PMC

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