Development of bone mineral density and content in children with cerebral palsy: a retrospective, longitudinal study

Philipp Koebke; Leonie Schafmeyer; Bruno Lentzen; Titus Keller; Eckhard Schoenau; Ibrahim Duran

doi:10.1515/jpem-2024-0519

Article

Development of bone mineral density and content in children with cerebral palsy: a retrospective, longitudinal study

Philipp Koebke , Leonie Schafmeyer , Bruno Lentzen , Titus Keller , Eckhard Schoenau and Ibrahim Duran

Published/Copyright: January 31, 2025

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 38 Issue 4

Abstract

Objectives

The aim of this study was to investigate long-term bone development in children with cerebral palsy (CP) using longitudinal measurements of total body less head bone mineral content (TBLH-BMC) and bone mineral density (TBLH-BMD).

Methods

A retrospective longitudinal analysis was performed on 109 children with CP who participated in a rehabilitation programme from 2006 to 2018. Dual-energy X-ray absorptiometry (DXA) scans were performed at the beginning of the programme and repeated as clinically indicated. The study used SITAR growth curve analysis and the LMS method within the GAMLSS model to generate developmental trajectories for TBLH-BMC and TBLH-BMD.

Results

The findings suggest that the expected developmental trajectories of TBLH-BMC and TBLH-BMD in children with CP approximately follow the third percentile of healthy children. The median annual increase in bone mineral density was similar between GMFCS I-II and III-V groups at 5.12 and 5.79 %, respectively. Girls with CP reached age at peak velocity (APV) earlier than boys. The intensive exercise programme may have contributed to greater annual bone growth in children with more severe CP.

Conclusions

Children with CP have bone growth trajectories close to the third percentile of their healthy peers, suggesting that age-adjusted z-scores for TBLH-BMC and BMD remain relatively stable throughout childhood and adolescence. Early and targeted interventions, including improving muscle strength and mobility and optimising nutritional and hormonal status, are essential to promote better bone health and quality of life in children with CP.

Keywords: cerebral palsy; children; bone mineral content; bone mineral density; longitudinal analysis; adolescents

Corresponding author: PD Dr. Ibrahim Duran, Center of Prevention and Rehabilitation, UniReha, University of Cologne, Medical Faculty and University Hospital, Lindenburger Allee 44, 50931 Cologne, Germany; and Department of Pediatrics, Cologne, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany, E-mail: Ibrahim.duran@unireha-koeln.de

Research ethics: The analysis was authorized by the local Ethic Committee (University of Cologne, ethical vote 16-269).
Informed consent: Informed consent was obtained from all individuals included in this study.
Author contributions: P.K., I.D. and E.S. designed the study. I.D. and P.K. was responsible for data analysis. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Use of Large Language Models, AI and Machine Learning Tools: We confirm that no large language models, AI, or machine learning tools were used in the conceptualization, analysis, or writing of this article.
Conflict of interest: P.K., I.D., E.S. and B.L. declare that they are employed at Center of Prevention and Rehabilitation, UniReha, Cologne, Germany. L.S. and T.K. state no conflict of interest.
Research funding: None declared.
Data availability: Due to ethical and privacy concerns, the data used in this study are not publicly available.

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Received: 2024-10-27

Accepted: 2025-01-16

Published Online: 2025-01-31

Published in Print: 2025-04-28

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Articles in the same Issue

https://doi.org/10.1515/jpem-2024-0519

Keywords for this article

cerebral palsy; children; bone mineral content; bone mineral density; longitudinal analysis; adolescents