Juvenile Osteoporosis in Children With Cerebral Palsy

Osteoporosis is a medical condition, commonly associated with old age, whereby the bones become fragile and brittle due to loss of tissue. It is often the result of hormonal changes, especially in postmenopausal women, or due to lack of sufficient calcium or vitamin D in the diet. Osteoporosis is also common in children suffering from cerebral palsy. Children with weakened bone mass are more likely to sustain bone fractures, even from minimal trauma, which can lead to a lifetime of crippling discomfort. There are steps that can be taken to maximize healthy bone development during all stages of growth.

Obtaining a diagnosis of osteoporosis in adults is a fairly simple process. A “dexa scan” (duel-energy x-ray absorptiometry) of the upper hip and lower spine is used to obtain what is known as a BMD (bone mineral density) score. It takes approximately 8-12 minutes, is painless and can be conducted at a hospital or clinic’s radiology department. Unfortunately, a low BMD score (below -2.0) is not enough to diagnose juvenile osteoporosis. The International Society of Clinical Densitometry requires physical evidence of a fragile skeleton, such as a history of bone break without trauma.

A child’s bones begin developing in the third week of gestation and continues through adolescence. Cerebral palsy can directly affect healthy bone growth in a number of ways. Because children with CP often have impaired movement, they may not be putting adequate stress on the bone structure–a key component to the mineralization process in the development of healthy bones. Children with CP who are confined to a wheelchair or bed might have limited access to the sun, thus depriving them of a major source of vitamin D, a major player in the absorption of calcium and bone growth. Children with CP sometimes have difficulty processing food which can affect their nutritional intake and lead to impairment in their growth process and the secretion of natural growth hormones from the pituitary gland. Medications taken to control CP-related seizures can also compromise the body’s natural ability to absorb calcium.

For children with cerebral palsy, regular physical therapy is vital in assuring the body receives adequate amounts of stress and encouragement of bone mineralization. Diet is also a vital component to healthy bone growth. Nutritional therapy is important because it is estimated that roughly 1/3 of children with CP suffer compromised malnutrition from related disorders such as GERD (gastro esophageal reflux) and respiratory infections. A nutritionist can assist in the assessment of your child’s nutrition and vitamin intake.

Calcium and vitamin D supplementation is instinctively felt to be an appropriate response to a child with low bone density, but can result in adverse side-effects if the child is also on anti-seizure medications. As with all vitamin and nutritional supplements, consult a physician before taking.

In recent years, growth hormone therapy and bisphosphonates (a drug, such as risedronic acid, that prevents loss of bone mass) have also been used with success.

Some bone disorders related to CP require surgery to correct. It is imperative that a child’s level of vitamin D be evaluated because recent studies have shown complications and poor bone healing in children with insufficient vitamin D levels.