title: Informing evidence-based clinical practice guidelines for children with cerebral palsy at risk of osteoporosis: a systematic review.
abstract: OBJECTIVE
  The aim of this systematic review was to inform evidence-based clinical practice guidelines for children with cerebral palsy (CP) and low bone mineral density (BMD).
  
  
  METHODS
  A computer-assisted literature search was focused on low BMD in children with CP, and was limited to the following interventions: weight-bearing activities, bisphosphonate use, and vitamin D or calcium supplementation. Articles were classified according to American Academy of Neurology guidelines and recommendation classifications were given based on the evidence for the intervention increasing BMD and decreasing fragility fractures. Studies were included if they were English-language full-text studies, focused on children with CP, and included at least 10 participants receiving the studied interventions.
  
  
  RESULTS
  Twenty-one articles underwent full-text review and data abstraction, including seven studies of weight-bearing activities, five studies of vitamin D or calcium supplementation, and nine studies of bisphosphonates administration. Overall, the evidence that bisphosphonates administration increases BMD was assessed as level B (probable) while the evidence that vitamin D or calcium supplementation does so was assessed as level C (possible); there was insufficient evidence to suggest that weight-bearing activities are an effective intervention to improve BMD. The evidence that bisphosphonates help to prevent fragility fractures was assessed as level C (possible); there was inadequate evidence to support the use of weight-bearing activities or vitamin D or calcium supplementation to decrease fragility fractures.
  
  
  CONCLUSIONS
  Evidence-based clinical practice guidelines were created outlining the suggested role of weight-bearing activities, vitamin D and calcium supplementation, and bisphosphonate use for children with CP with low BMD at risk of fragility fractures.
authors: Department of Paediatrics, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, Canada. dfehlings@hollandbloorview.ca
authors: Darcy
authors: D
authors: Fehlings
authors: Lauren
authors: L
authors: Switzer
authors: Payal
authors: P
authors: Agarwal
authors: Charles
authors: C
authors: Wong
authors: Etienne
authors: E
authors: Sochett
authors: Richard
authors: R
authors: Stevenson
authors: Lyn
authors: L
authors: Sonnenberg
authors: Sharon
authors: S
authors: Smile
authors: Elizabeth
authors: E
authors: Young
authors: Joelene
authors: J
authors: Huber
authors: Golda
authors: G
authors: Milo-Manson
authors: Ghassan Abu
authors: GA
authors: Kuwaik
authors: Deborah
authors: D
authors: Gaebler
mesh_terms: D015519:Bone Density; D002547:Cerebral Palsy / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D016208:Databases, Factual / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine / Q000379:methods* / Q000592:standards*; D005459:Fluorides; D006801:Humans; D010024:Osteoporosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D010710:Phosphates; D017410:Practice Guidelines as Topic; D016474:Weight-Bearing
chemical_list: D010710:Phosphates; C012980:fluorophosphate; D005459:Fluorides