title: Longitudinal assessment of bone growth and development in a facility-based population of young adults with cerebral palsy.
abstract: OBJECTIVE
  Osteoporosis is a significant clinical problem in persons with moderate to severe cerebral palsy (CP), causing fractures with minimal trauma. Over the past decade, most studies examining osteoporosis and CP have been cross-sectional in nature, focused exclusively on children and adolescents and only involving one evaluation of bone mineral density (BMD). The purpose of this study was to assess BMD in a group including adults with CP, and changes in each individual's BMD over a 5- to 6-year period.
  
  
  METHODS
  The study group included 40 residents of a long-term care facility aged 6 to 26 years at the time of their initial evaluation. Twenty-one patients (52.5%) were male, 35 (88%) were white, and 38 (95%) were in Gross Motor Function Classification System level V. BMD was assessed by dual-energy X-ray absorptiometry on the right and left distal femurs for three distinct regions of interest.
  
  
  RESULTS
  Five residents had a fracture that occurred during the study period; this represented a fracture rate of 2.1% per year in the study group. Longitudinally, annualized change in the median BMD was 0.7% to 1.0% per year in the different regions of the distal femur, but ranged widely among the study group, with both increases and decreases in BMD. Increase in BMD over time was negatively correlated with age and positively correlated with change in weight.
  
  
  CONCLUSIONS
  Changes in BMD over time in profoundly involved persons with CP can range widely, which is important to recognize when evaluating potential interventions to improve BMD. Age and changes in body weight appear the most relevant factors.
authors.affiliation: Hattie Larlham Center for Children with Disabilities, Mantua, OH, USA.|Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.|Rainbow Babies & Children's Hospital, Cleveland, OH, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Grossberg
authors.affiliation: Department of Pediatrics, Northeast Ohio Medical University, Rootstown, OH, USA.|Division of Clinical Pharmacology & Toxicology, Akron Children's Hospital, Akron, OH, USA.|Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH, USA.
authors.forename: Martha G
authors.initials: MG
authors.lastname: Blackford
authors.affiliation: Department of Biomedical Research, Nemours/A.I. duPont Hospital for Children, Wilmington, DE, USA.|Department of Medical Imaging, Nemours/A.I. duPont Hospital for Children, Wilmington, DE, USA.
authors.forename: Heidi H
authors.initials: HH
authors.lastname: Kecskemethy
authors.affiliation: Department of Orthopaedics, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Henderson
authors.affiliation: Hattie Larlham Center for Children with Disabilities, Mantua, OH, USA.|Department of Pediatrics, Northeast Ohio Medical University, Rootstown, OH, USA.|Division of Clinical Pharmacology & Toxicology, Akron Children's Hospital, Akron, OH, USA.|Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Reed
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D015519:Bone Density / Q000502:physiology*; D002547:Cerebral Palsy / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D012307:Risk Factors; D055815:Young Adult