Bone-mineral density in children and adolescents who have spastic cerebral palsy.
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.
Henderson
R C
RC
University of North Carolina at Chapel Hill 27599-7055, USA.
Lin
P P
PP
Greene
W B
WB
D000293:Adolescent; D000704:Analysis of Variance; D015992:Body Mass Index; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D002117:Calcitriol / Q000097:blood; D002136:Calcium, Dietary; D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000097:blood / Q000150:complications* / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005269:Femur / Q000473:pathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009748:Nutrition Disorders / Q000150:complications / Q000209:etiology; D012044:Regression Analysis; D012885:Skinfold Thickness; D018709:Statistics, Nonparametric; D016138:Walking
D002136:Calcium, Dietary; D002117:Calcitriol