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Review Article

Low bone mineral density in ambulatory persons with cerebral palsy? A systematic review

, , , , &
Pages 2392-2402 | Received 01 Mar 2017, Accepted 24 Apr 2018, Published online: 22 May 2018
 

Abstract

Purpose: Non-ambulatory persons with cerebral palsy are prone to low bone mineral density. In ambulatory persons with cerebral palsy, bone mineral density deficits are expected to be small or absent, but a consensus conclusion is lacking. In this systematic review bone mineral density in ambulatory persons with cerebral palsy (Gross Motor Function Classification Scales I–III) was studied.

Materials and methods: Medline, Embase, and Web of Science were searched. According to international guidelines, low bone mineral density was defined as Z-score ≤ −2.0. In addition, we focused on Z-score ≤ −1.0 because this may indicate a tendency towards low bone mineral density.

Results: We included 16 studies, comprising 465 patients aged 1–65 years. Moderate and conflicting evidence for low bone mineral density (Z-score ≤ −2.0) was found for several body parts (total proximal femur, total body, distal femur, lumbar spine) in children with Gross Motor Function Classification Scales II and III. We found no evidence for low bone mineral density in children with Gross Motor Function Classification Scale I or adults, although there was a tendency towards low bone mineral density (Z-score ≤ −1.0) for several body parts.

Conclusions: Although more high-quality research is needed, results indicate that deficits in bone mineral density are not restricted to non-ambulatory people with cerebral palsy.

    Implications for Rehabilitation

  • Although more high-quality research is needed, including adults and fracture risk assessment, the current study indicates that deficits in bone mineral density are not restricted to non-ambulatory people with CP.

  • Health care professionals should be aware that optimal nutrition, supplements on indication, and an active lifestyle, preferably with weight-bearing activities, are important in ambulatory people with CP, also from a bone quality point-of-view.

  • If indicated, medication and fall prevention training should be prescribed.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

No commercial party has a financial interest in the results of the research supporting this article or will confer a benefit to the authors or any organization with which the authors are associated.