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The Journal of Bone and Joint Surgery, Vol 77, Issue 11 1671-1681, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Bone-mineral density in children and adolescents who have spastic cerebral palsy
RC Henderson, PP Lin and WB Greene
University of North Carolina at Chapel Hill 27599-7055, USA.
Bone-mineral density was studied in a heterogeneous group of 139 children
(mean age, nine years; range, three to fifteen years) who had spastic
cerebral palsy. The evaluation included serum analyses and a nutritional
assessment based on a dietary history and anthropometric measurements. The
bone-mineral density of the proximal parts of the femora and the lumbar
spine was measured with dual-energy x-ray absorptiometry and was normalized
for age against a series of ninety-five normal children and adolescents who
served as controls. Bone-mineral density varied greatly but averaged nearly
one standard deviation below the age-matched normal means for both the
proximal parts of the femora (-0.92 standard deviation) and the lumbar
spine (-0.80 standard deviation). Ambulatory status was the factor that
best correlated with bone-mineral density. Nutritional status, assessed on
the basis of caloric intake, skinfolds, and body-mass index, was the second
most significant variable. The pattern of involvement, durations of
immobilization in a cast, and a calcium intake of less than 500 milligrams
per day were additional factors of less significance. The age when the
child first walked, previous fractures, use of anticonvulsants, and serum
vitamin-D levels did not correlate with bone-mineral density after
adjustment for covariance with the ambulatory status and the nutritional
status. Serum levels of calcium, phosphate, alkaline phosphatase, and
osteocalcin were not reliable indicators of low bone-mineral density.
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