Features of the state of bone tissue in children with cerebral palsy. Part 1. Etiological aspects. A literature review

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Abstract

BACKGROUND: The growth of the human body is the most significant period of development of the bone tissue, because it is during this period that the size, shape, and architectonics of bone are formed against the background of increasing body weight and increasing physical exertion. Considering a number of pathological factors of the underlying disease (alimentary, neurological, hormonal, stress, and physical), bone tissue in children with cerebral palsy grows and develops with deviations from the norm.

АIM: To present up-to-date generalized information about the features of bone tissue in children with cerebral palsy to orthopedic traumatologists, neurologists, and physical therapy specialists.

MATERIALS AND METHODS: Studies on the problem of bone tissue condition in patients with cerebral palsy were analyzed. Data published over the past 20 years were searched in the scientific databases PubMed, Google Scholar, Cochrane Library, Crossref, and eLibrary without language restrictions.

RESULTS: In the last 20 years, the number of studies about pediatric osteoporosis has increased. The gold standard for determining the level of bone mineral density is dual-energy X-ray absorptiometry. However, its use in children has presented some difficulties and limitations. In children, the relationship between bone mineral density values and the risk of fractures has not been well studied, which does not allow us to discuss about osteoporosis based on densitometric bone mineral density data alone. In patients with cerebral palsy, a decrease in bone mineral density and bone mass during growth was found. Previous studies showed that the main factors associated with a decrease in bone mineral density in this group of patients include neuroendocrine causes due to growth retardation against the background of CNS damage, alimentary factors, decreased calcium and vitamin D concentrations, systemic use of glucocorticoids, intake of antiepileptic drugs, decreased motor activity, and low muscle mass. Increasing serum vitamin D concentrations does not have a positive effect on bone mass, although increasing serum calcium concentrations is associated with an increase in bone mineral density.

CONCLUSIONS: Identifying and correcting factors leading to decreased bone mineral density in children with cerebral palsy can improve bone health in this group of patients. The absence of a relationship between bone mineral density values and the risk of fractures in children with cerebral palsy does not allow us to discuss about osteoporosis based only on bone mineral density densitometric data. There may be more factors leading to an increased risk of bone fractures in children with cerebral palsy that require further study.

About the authors

Vladimir A. Novikov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: novikov.turner@gmail.com
ORCID iD: 0000-0002-3754-4090
SPIN-code: 2773-1027

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Valery V. Umnov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: umnovvv@gmail.com
ORCID iD: 0000-0002-5721-8575
SPIN-code: 6824-5853

MD, PhD, Dr. Sci. (Medicine)

Russian Federation, Saint Petersburg

Dmitry S. Zharkov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: striker5621@gmail.com
ORCID iD: 0000-0002-8027-1593

MD

Russian Federation, Saint Petersburg

Dmitry V. Umnov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: dmitry.umnov@gmail.com
ORCID iD: 0000-0003-4293-1607
SPIN-code: 1376-7998

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Alina R. Mustafaeva

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: alina.mys23@yandex.ru
ORCID iD: 0009-0003-4108-7317

PhD student

Russian Federation, Saint Petersburg

Olga V. Barlova

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: barlovaolga@gmail.com
ORCID iD: 0000-0002-0184-135X

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

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