Low bone mineral density in ambulatory persons with cerebral palsy? A systematic review
Creators: name: Mus-Peters, Cindy T. R.
name: Bionka M. A. Huisstede
name: Noten, Suzie
name: Minou W. M. G. C. Hitters
name: Slot, Wilma M. A. Van Der
name: Rita. J. G. Van Den Berg-Emons
Publisher: name: Taylor & Francis
Year: 2018
Subjects: subject: Medicine
subject: Physiology
subject: FOS: Biological sciences
subject: FOS: Biological sciences
subject: Biotechnology
subject: 59999 Environmental Sciences not elsewhere classified
subject: FOS: Earth and related environmental sciences
subject: FOS: Earth and related environmental sciences
subject: Sociology
subject: FOS: Sociology
subject: FOS: Sociology
subject: Cancer
subject: Science Policy
subject: Computational Biology

description: <b>Purpose:</b> Non-ambulatory persons with cerebral palsy are prone to low bone mineral density. In ambulatory persons with cerebral palsy, bone mineral density deficits are expected to be small or absent, but a consensus conclusion is lacking. In this systematic review bone mineral density in ambulatory persons with cerebral palsy (Gross Motor Function Classification Scales I–III) was studied. <b>Materials and methods:</b> Medline, Embase, and Web of Science were searched. According to international guidelines, low bone mineral density was defined as <i>Z</i>-score ≤ −2.0. In addition, we focused on <i>Z</i>-score ≤ −1.0 because this may indicate a tendency towards low bone mineral density. <b>Results:</b> We included 16 studies, comprising 465 patients aged 1–65 years. Moderate and conflicting evidence for low bone mineral density (<i>Z</i>-score ≤ −2.0) was found for several body parts (total proximal femur, total body, distal femur, lumbar spine) in children with Gross Motor Function Classification Scales II and III. We found no evidence for low bone mineral density in children with Gross Motor Function Classification Scale I or adults, although there was a tendency towards low bone mineral density (<i>Z</i>-score ≤ −1.0) for several body parts. <b>Conclusions:</b> Although more high-quality research is needed, results indicate that deficits in bone mineral density are not restricted to non-ambulatory people with cerebral palsy.Implications for RehabilitationAlthough more high-quality research is needed, including adults and fracture risk assessment, the current study indicates that deficits in bone mineral density are not restricted to non-ambulatory people with CP.Health care professionals should be aware that optimal nutrition, supplements on indication, and an active lifestyle, preferably with weight-bearing activities, are important in ambulatory people with CP, also from a bone quality point-of-view.If indicated, medication and fall prevention training should be prescribed. Although more high-quality research is needed, including adults and fracture risk assessment, the current study indicates that deficits in bone mineral density are not restricted to non-ambulatory people with CP. Health care professionals should be aware that optimal nutrition, supplements on indication, and an active lifestyle, preferably with weight-bearing activities, are important in ambulatory people with CP, also from a bone quality point-of-view. If indicated, medication and fall prevention training should be prescribed.