title: Skeletal Maturation and Mineralisation of Children with Moderate to Severe Spastic Quadriplegia.
abstract: BACKGROUND
  Diminished bone mineral density and delayed skeletal maturation are common in children with spastic quadriplegia.
  
  
  OBJECTIVE
  The purpose of our study was to evaluate the Bone Mineral Density (BMD) of children with moderate to severe spastic quadriplegia and its relationship with other variables like nutrition and growth.
  
  
  METHODS
  This was a hospital based, cross- sectional, case-control study. Forty-two (28 males, 14 females) children with spastic quadriplegia and 42 (24 males, 18 females) healthy children were included in the study. BMD of cases and control were measured by Dual Energy X-ray Absorptiometry (DEXA). Radiographs of left hand and wrist of cases and controls were taken and bone age was determined.
  
  
  RESULTS
  BMD values of upper extremity, lower extremity, thoraco-lumbar spine and pelvis in cases were lower than those of controls (p <0.0001). In children with non severe malnutrition, 75% of the cases had lower bone age than chronological age, whereas all cases with severe malnutrition had lower bone age than chronological age. Step wise regression analysis showed that nutritional status independently contributed to lower BMD values but the BMD values did not correlate significantly with the use of anticonvulsant drugs and presence of physical therapy.
  
  
  CONCLUSIONS
  Decreased BMD and delayed bone age is prevalent in children with spastic quadriplegia and nutritional status is an important contributing factor.
authors: Senior Resident, Department of Pediatric Medicine, VMMC and Safdarjung Hospital , New Delhi, India .
authors: Indar Kumar
authors: IK
authors: Sharawat
authors: Professor and Head of Department, Department of Pediatric Medicine, SMS Medical College , Jaipur, Rajasthan, India .
authors: Sadasivan
authors: S
authors: Sitaraman
keywords: Anti-epileptic drugs; Bone mineral density; Cerebral palsy; Dual energy X-ray absorptiometry; Nutritional status; Physical activity