Bone Health in Children with Cerebral Palsy in an Orthopedic Outpatient Setting: The Role of Functional Severity

Abstract

Aim: Cerebral palsy (CP) entails lifelong impairments in movement and posture resulting from non-progressive brain damage. As overall life expectancy increases due to advancements in neonatal conditions, the significance of long-term musculoskeletal health concerns in individuals with CP has grown correspondingly. This study aims to assess bone mineral density (BMD) in pediatric and adolescent populations with CP and investigate clinical, functional, and biochemical factors associated with osteoporosis.Material and Methods: The study included 71 children and adolescents diagnosed with CP. Demographic data, anthropometric measurements, pubertal status, gross motor function classification system (GMFCS) level, treatment details, and fracture history were obtained from hospital records. Serum biochemical parameters and vitamin D levels, vertebral fractures, and lumbar spine BMD measured by dual-energy X-ray absorptiometry were evaluated. Osteoporosis classification was determined using Z-scores.Results: A significant negative correlation was found between GMFCS level and BMD. The osteoporosis group had lower albumin levels, while alkaline phosphatase (ALP) values varied between groups. Patients on anticonvulsants showed reduced calcium and corrected calcium levels, but there was no statistically significant difference in BMD. The rate of osteoporosis was similar across subgroups based on vitamin D status. Additionally, no notable differences were observed between osteoporosis groups in body mass index (BMI) or BMI-standard deviation scores.Conclusion: Metabolic factors, vitamin D levels, and functional limitations influence bone health and the development of secondary osteoporosis in children with CP. GMFCS levels are also a key determinant of bone health. A proactive, multidisciplinary evaluation of bone health is essential for preventing fractures and improving mobility.