Finbråten A-K, Syversen U, Skranes J, Andersen G L, Stevenson R D, Vik T
Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Olav Kyrres gt.11, 7489, Trondheim, Norway,
Osteoporos Int. 2015 Jan;26(1):141-50. doi: 10.1007/s00198-014-2840-0. Epub 2014 Aug 14.
This study assessed distal femur and lumbar spine bone mineral density (BMD) Z-scores in children with cerebral palsy. BMD z-score was lower in non-ambulatory than in ambulatory children. Somewhat surprisingly, among ambulatory children, those with better walking abilities had higher BMD z-score than those with more impaired walking ability.
Children with cerebral palsy (CP) have increased risk for low bone mineral density (BMD). The aim was to explore the difference in BMD at the distal femur and lumbar spine between ambulatory and non-ambulatory children with CP and the relationship between vitamin D status and BMD.
Fifty-one children (age range 8-18 years; 20 girls) with CP participated. Their BMD Z-scores were measured in the lumbar spine and the distal femur using dual X-ray absorptiometry, and 25-hydroxy-vitamin D (25-OHD) concentrations were measured in serum. Children with GMFCS level I-III were defined as 'walkers' while children with level IV-V were defined as 'non-walkers.
Non-walkers had lower mean BMD Z-scores (range -1.7 to -5.4) than walkers at all sites (range -0.8 to -1.5). Among walkers, BMD Z-scores at the distal femur were lower in those with GMFCS level II than with level I (p values < 0.004). A similar difference was found between the affected and unaffected limb in children with hemiplegia. Mean 25-OHD concentration was 45 nmol/L (SD = 18); lower in walkers (mean = 41 nmol/L; SD = 18) than in non-walkers (mean = 53 nmol/L; SD = 19; p = 0.041). There were no correlations between 25-OHD and BMD z-scores.
The main predictor of low BMD Z-scores in the distal femur was the inability to walk, but the results suggest that the degree of the neuromotor impairment may also be a significant predictor. Vitamin D status did not correlate with BMD z-scores.
本研究评估了脑瘫患儿股骨远端和腰椎的骨密度（BMD）Z评分。非行走型脑瘫患儿的骨密度Z评分低于行走型患儿。 somewhat令人惊讶的是，在行走型患儿中，行走能力较好的患儿骨密度Z评分高于行走能力受损更严重的患儿。
脑瘫（CP）患儿骨密度（BMD）降低的风险增加。目的是探讨行走型和非行走型脑瘫患儿股骨远端和腰椎骨密度的差异以及维生素D状态与骨密度的关系。
51名年龄在8至18岁之间的脑瘫患儿（20名女孩）参与了研究。使用双能X线吸收法测量他们腰椎和股骨远端的骨密度Z评分，并测量血清中25-羟基维生素D（25-OHD）的浓度。GMFCS水平为I-III级的患儿被定义为“行走者”，而IV-V级的患儿被定义为“非行走者”。
在所有部位，非行走者的平均骨密度Z评分（范围为-1.7至-5.4）低于行走者（范围为-0.8至-1.5）。在行走者中，GMFCS II级患儿股骨远端的骨密度Z评分低于I级患儿（p值<0.004）。偏瘫患儿患侧和未患侧之间也发现了类似差异。平均25-OHD浓度为45 nmol/L（标准差=18）；行走者（平均=41 nmol/L；标准差=18）低于非行走者（平均=53 nmol/L；标准差=19；p = 0.041）。25-OHD与骨密度Z评分之间无相关性。
股骨远端骨密度Z评分低的主要预测因素是无法行走，但结果表明神经运动损伤程度也可能是一个重要的预测因素。维生素D状态与骨密度Z评分无关。
