Relationship of Bone Marrow Density (Hip and Spine) in Cerebral Palsy: A Case-Control Study
Abstract
Cerebral palsy (CP) is the most common physical disability of childhood. Children with CP frequently grow slowly and are more prone to fractures. So this study was aimed to explore relationship of bone mineral density (BMD) with cerebral palsy by case-control study. This study was conducted at Department of Physical Medicine and Rehabilitation of Sawai Man Singh Medical College, Jaipur. Hip bone and spine bone was used to assess BMD. Bone mineral density was measured by DEXA in both groups i.e. study group and control group after ensuring the comparability of both groups. Difference in means of BMD in both the groups was inferred by unpaired student's’ test of significance. It was found in this study that bone mineral density of hip well as spine was significantly lowered in cerebral palsy cases.
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Introduction
Cerebral palsy (CP) is the most common physical disability of childhood.1 Estimated prevalence of cerebral palsy is 2.5 per 1000 population. In recent years, the incidence rate of CP has been increasing internationally due to increased survival of low birth weight infants. 2 Most children with cerebral palsy are undernourished, while 8% to 14% are overweight.3 The caloric intake of children with CP is lower than that of age-matched controls.4 Gastroesophageal reflux affects a significant proportion of children with CP. 5 Frequent emesis and regurgitation may be a source of caloric loss. Reflux esophagitis may cause discomfort leading to food refusal and further decreasing food intake.6
Oromotor dysfunction affects upto 90% of patients with CP7 and is a major contributor to malnutrition in children with CP.8,9 Inadequate sucking, dysfunctional swallowing, persistent extrusion reflex, drooling due to inadequate lip closure and reduced ability to chew make oral feeding difficult.9 Children with CP frequently grow slowly. The impact of this altered growth on skeletal development and bone density is a significant health problem. 10 Vitamin D plays a role in bone mineralization by maintaining adequate levels of calcium and phosphorus in the blood. This allows the osteoblasts to lay down bone matrix. The production of 1, 25(OH) 2D is regulated by serum calcium levels through the action of parathyroid hormone (PTH) and phosphorus.11
Conclusion
It was found in this study that bone mineral density of hip well as spine was significantly lowered in cerebral palsy cases.