CEREBRAL PALSY: STRONG BONES, HEALTHY KIDS

Take away points on CP and bone mineral density - ask your neurologist. 

• Children with cerebral palsy (CP) have low bone mineral density, which means their bones are weak and at increased risk for fragilityfractures.

•  In order  to learn more about how to improve bone mineral density and prevent  fragility  fractures, a group of researchers  from Canada and  the USA conducted a systematic(review and created a clinical(practice(guideline for parents and health care providers. 

•  There is insufficient evidence to say that weight-bearing activities improve bone mineral density or prevent fractures. Still, given the safety and other  benefits of these activities, a physiotherapy consult is indicated in children with CP.

•  Calcium and vitamin D are possibly  effective in  improving  bone mineral  density,  but  there is  not  enough  evidence  to  say  vitamin  D  and  calcium prevent  fragility  fractures. Recommended daily intakes of calcium are available  for children and can be used in children with CP as well. Vitamin D  supplementation is recommended at doses of 800-1000IU daily. Blood-work and urine tests should be done at baseline and at 6-12 months. 

•  Bisphosphonates are probably effective in improving bone mineral density in children with CP and reducing fragility fractures in children who have  had fractures in the past. Given the risk of adverse effects and lack of information on the long term impact of bisphosphonates, consultation with a bone  health specialist and consideration of bisphosphonates is recommended only after the child with CP sustains a fragility fracture. 

•  DXA scans are recommended only following a fragility fracture.

Future research that evaluates osteoporosis interventions that are appropriately powered for fragility fractures as a primary outcome is critically  important  to inform  practice.  Population based studies  are  also  required  to  obtain more  accurate  information  on  prevalence  rates  of  low  bone mineral density and fragility fracture in children with CP, as well as their impact on pain and quality of life. 

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