Sheridan Kevin J
Department of Pediatrics, Gillette Children's Specialty Care, Saint Paul, MN 55101, USA.
Dev Med Child Neurol. 2009 Oct;51 Suppl 4:38-51. doi: 10.1111/j.1469-8749.2009.03432.x.
Life expectancy for the 400 000 adults with cerebral palsy (CP) in the USA is increasing. Although there is a perception of increased fractured rate in the adult with CP, it has not been well studied. Low bone mineral density is found in more than 50% of adults with a variety of disabilities, including CP. Dual-energy X-ray absorptiometry scanning is commonly used to assess bone mineral density, but is limited by positioning and other artifacts in adults with CP. Novel scanning regions of interest, such as the distal femur, are not yet standardized in adults. Nutritional assessment and physical activity, the basis of most fracture prevention programs, are difficult to do in the adult with CP. A better understanding of the 'muscle-bone unit' physiology and its exploitation may lead to better treatment modifications. Clinical research trials with bisphosphonates (e.g. pamidronate), estrogen, selective estrogen receptor modulators, parathyroid hormone analogs, and growth hormone need to be targeted to the adult with CP. Longitudinal studies of fracture risk factors, genetic research in bone and neuromuscular biology, and the development of treatment surrogates for physical activity are additional areas of needed expertise. This could be facilitated by an adult CP registry and the centralization of clinical research efforts.
美国40万成年脑瘫患者的预期寿命正在增加。尽管人们认为成年脑瘫患者的骨折率有所上升，但对此尚未进行充分研究。超过50%的包括脑瘫患者在内的各类残疾成年人存在低骨密度问题。双能X线吸收测定扫描常用于评估骨密度，但在成年脑瘫患者中受体位及其他伪影的限制。诸如股骨远端等新的感兴趣扫描区域在成年人中尚未标准化。营养评估和体育活动是大多数骨折预防项目的基础，但在成年脑瘫患者中难以实施。更好地理解“肌肉-骨骼单位”生理学并加以利用可能会带来更好的治疗调整。针对成年脑瘫患者开展双膦酸盐（如帕米膦酸）、雌激素、选择性雌激素受体调节剂、甲状旁腺激素类似物及生长激素的临床研究试验很有必要。骨折风险因素的纵向研究、骨骼和神经肌肉生物学的基因研究以及体育活动治疗替代指标的开发是其他需要专业知识的领域。建立成年脑瘫患者登记处并集中临床研究工作可能会推动这些方面的进展。
