Article Figures & Data
Figures
- Fig 1.
BMD z scores in region 3 of the distal femur as a function of age (years). Best fit linear regression line shown.
- Fig 2.
BMD z scores in region 3 of the distal femur as a function of severity of CP as defined by the GMFC scale. Mean ± SE bars shown.
- Fig 3.
BMD z scores in the lumbar spine as a function of nutritional status as defined by triceps skinfold z score. Best fit linear regression line shown.
- Fig 4.
BMD z scores in the distal femur (region 1) as a function of the caregiver’s reported difficulty feeding the child. Mean ± SE bars shown.
- Fig 5.
Serum markers of bone resorption (N-telopeptides in nmoles bone collagen equivalents/L) versus bone formation (osteocalcin in ng/mL). Best fit linear regression line shown.
Tables
Population Based Convenience Sample P Value* Demographic variables Age (y) Mean ± SE 9.7 + 0.6 9.6 + 0.6 ≥.2 Range 2.0–19.0 2.1–18.2 Gender (male:female) n 36:26 35:20 ≥.2 % 58%:42% 64%:36% Race (white:black:other) n 41:21:0 35:16:4 ≥.2 % 66%:34%:0% 64%:29%:7% Clinical variables GMFC level (levels 3:4:5) n 16:17:29 2:10:43 .0005 % 26%:27%:47% 4%:18%:78% Anticonvulsants (never:past only:current) n 20:17:25 12:14:29 ≥.2 % 32%:27%:40% 22%:25%:53% Fracture (no:yes) n 55:7 44:11 ≥.2 % 89%:11% 80%:20% Lower limb or scoliosis surgery (no:yes) n 29:33 28:27 ≥.2 % 47%:53% 51%:49% CHQ z score (mean ± SE) −0.9 + 0.2 −0.8 + 0.2 ≥.2 Nutrition variables Feeding difficulty (no:mild:mod:severe) n 33:8:5:16 15:9:6:25 .04 % 53%:13%:8%:26% 27%:16%:11%:45% Triceps skinfold z score (mean ± SE) −0.4 + 0.1 −0.9 + 0.2 .04 Tube feedings ever (no:yes) n 29:33 25:30 ≥.2 % 47%:53% 45%:55% Serum transthyretin level (mean ± SE) 22.6 + 0.9 21.3 + 0.8 ≥.2 Growth variables Height z score (mean ± SE) −2.5 + 0.2 −3.3 + 0.3 .01 Weight z score (mean ± SE) −1.8 + 0.3 −3.5 + 0.4 .002 Bone density variables Distal femur z scores Region 1 (mean ± SE) −2.6 + 0.2 −3.6 + 0.2 .001 Region 2 (mean ± SE) −2.8 + 0.2 −3.8 + 0.2 .003 Region 3 (mean ± SE) −2.6 + 0.2 −3.7 + 0.3 .001 Lumbar spine z score (mean ± SE) −1.8 + 0.1 −2.3 + 0.1 .006 ↵* Statistical comparison between the population-based and convenience cohorts.
N Mean BMD z Score ± SE Distal Femur Region 2 Lumbar Spine Demographic variables Age 2.0–5.9 y 31 −2.9 ± 0.4 −2.5 ± 0.2 6.0–11.9 y 50 −3.0 ± 0.2 −1.8 ± 0.1 12.0–19.0 y 36 −3.7 ± 0.3 −2.0 ± 0.2 P = .01 P ≥ .2 Gender Boys 71 −3.1 ± 0.2 −2.1 ± 0.1 Girls 46 −3.6 ± 0.3 −1.9 ± 0.2 P = .1 P ≥ .2 Race White/other 80 −3.5 ± 0.2 −2.0 ± 0.1 Black 37 −2.7 ± 0.2 −2.1 ± 0.2 P = .01 P ≥ 0.2 Clinical variables GMFC level Level 3 18 −1.8 ± 0.3 −1.5 ± 0.2 Level 4 27 −3.1 ± 0.3 −1.9 ± 0.2 Level 5 72 −3.8 ± 0.2 −2.2 ± 0.1 P < .0001 P = .03 Anticonvulsants Never 32 −2.5 ± 0.3 −2.1 ± 0.2 Past only 31 −3.0 ± 0.3 −1.8 ± 0.1 Current 54 −3.8 ± 0.2 −2.2 ± 0.2 P < .003 P ≥ .2 Fracture No 99 −3.1 ± 0.2 −2.0 ± 0.1 Yes 18 −3.9 ± 0.4 −2.2 ± 0.4 P = .06 P ≥ .2 Temporary immobilization Never 58 −3.1 ± 0.3 −2.2 ± 0.1 Brief 17 −3.8 ± 0.4 −1.7 ± 0.4 Prolonged 42 −3.2 ± 0.2 −2.0 ± 0.2 P ≥ .2 P ≥ .2 Children’s Health Status Questionnaire z score >−1.0 54 −2.9 ± 0.2 −1.9 ± 0.1 −1.0 to −2.0 24 −3.1 ± 0.4 −2.4 ± 0.2 <−2.0 31 −3.7 ± 0.3 −2.1 ± 0.3 P ≥ .2 P = .09 Nutrition variables Triceps skinfold z score >0 31 −3.0 ± 0.3 −1.6 ± 0.2 0 to −1.0 32 −3.4 ± 0.3 −2.1 ± 0.2 −1.0 to −2.0 46 −3.3 ± 0.3 −2.3 ± 0.2 <−2.0 8 −3.5 ± 0.5 −1.9 ± 0.3 P ≥ .2 P = .003 Feeding problems None 48 −2.6 ± 0.3 −1.7 ± 0.1 Mild 17 −2.9 ± 0.3 −2.2 ± 0.3 Moderate 11 −4.4 ± 0.8 −2.3 ± 0.3 Severe 41 −3.9 ± 0.2 −2.3 ± 0.2 P = .0003 P = .02 Currently tube fed No 84 −2.9 ± 0.2 −2.0 ± 0.1 Yes 33 −4.0 ± 0.3 −2.3 ± 0.2 P = .001 P ≥ .2 Calcium intake Adequate (>1000) 64 −3.2 ± 0.2 −1.9 ± 0.1 Marginal (500–1000) 46 −3.3 ± 0.3 −2.1 ± 0.2 Low (<500 mg/d) 7 −3.4 ± 0.5 −2.7 ± 0.4 P ≥ .2 P ≥ .2 Serum transthyretin Normal (>18 mg/dL) 51 −3.4 ± 0.3 −2.0 ± 0.1 Marginal (16–18 mg/dL) 7 −3.6 ± 0.6 −2.9 ± 0.3 Low (<16 mg/dL) 5 −3.4 ± 0.5 −2.9 ± 0.7 P ≥ .2 P = .02 Growth variables Height z score (based on sitting knee height) >−1.0 15 −2.5 ± 0.3 −1.9 ± 0.4 −1.0 to −2.0 25 −2.8 ± 0.4 −1.8 ± 0.2 <−2.0 77 −3.6 ± 0.2 −2.2 ± 0.1 P = .0003 P ≥ .2 Weight z score >−1.0 31 −2.5 ± 0.3 −1.4 ± 0.2 −1.0 to −2.0 27 −3.0 ± 0.2 −2.2 ± 0.2 <−2.0 59 −3.9 ± 0.2 −2.3 ± 0.1 P < .0001 P = .0001 Arm circumference z score >0 36 −2.6 ± 0.3 −1.3 ± 0.1 0 to −1.0 22 −3.0 ± 0.4 −2.2 ± 0.3 −1.0 to −2.0 28 −3.2 ± 0.3 −2.2 ± 0.2 <−2.0 31 −4.4 ± 0.3 −2.6 ± 0.1 P < .0001 P < .0001 Other serum variables 25 OHD Adequate (>20 ng/mL) 36 −3.5 ± 0.3 −2.2 ± 0.2 Marginal (15–20 ng/mL) 27 −3.4 ± 0.3 −2.2 ± 0.2 Low (<15 ng/mL) 13 −3.2 ± 0.4 −2.2 ± 0.3 P ≥ .2 P ≥ .2 N-telopeptides (bone resorption marker) Low tertile (<41 nm/L) 24 −3.5 ± 0.4 −1.8 ± 0.2 Mid tertile (41–57 nm/L) 23 −3.3 ± 0.4 −2.2 ± 0.2 High tertile (>57 nm/L) 24 −3.1 ± 0.3 −2.2 ± 0.3 P ≥ .2 P ≥ .2 Osteocalcin (bone formation marker) Low tertile (<38 ng/mL) 25 −3.9 ± 0.5 −2.4 ± 0.2 Mid tertile (38–59 ng/mL) 25 −3.3 ± 0.3 −2.2 ± 0.2 High tertile (>59 ng/mL) 26 −3.3 ± 0.3 −1.9 ± 0.3 P ≥ .2 P ≥ .2 Abnormal phosphorous, calcium, or alkaline phosphatase No 62 −3.3 ± 0.2 −2.2 ± 0.1 Yes 13 −4.0 ± 0.6 −2.2 ± 0.3 P ≥ .2 P ≥ .2
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Bone Density and Metabolism in Children and Adolescents With Moderate to Severe Cerebral Palsy
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Subjects
Keywords
- cerebral palsy
- bone mineral density
- osteoporosis
- pediatrics
- bone metabolism
- growth
- nutrition, osteopenia
- CP, cerebral palsy
- 25-OHD, 25-hydroxy vitamin D
- NAGCePP, North American Growth in Cerebral Palsy Project
- GMFC, Gross Motor Functional Classification scale
- UNC, University of North Carolina
- CHOP, Children’s Hospital of Philadelphia
- DXA, dual-energy X-ray absorptiometry
- BMD, bone mineral density
- SE, standard error