Marciniak C, Gabet J, Lee J, Ma M, Brander K, Wysocki N
Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
Department of Neurology, Northwestern University, Chicago, IL, USA.
Osteoporos Int. 2016 Apr;27(4):1477-1484. doi: 10.1007/s00198-015-3393-6. Epub 2015 Nov 17.
This study aims to describe osteoporosis screening in adults with cerebral palsy (CP) and identify any associated factors. Bone mineral density (BMD) was often lower than expected-for-age in these adults, and present even in young adulthood, particularly at the spine. Low BMD is frequent in adults with CP.
This study aims to describe the feasibility of dual-energy X-Ray absorptiometry (DXA) screening in adults with cerebral palsy (CP) and identify factors associated with low bone mineral density (BMD), including longitudinal changes.
A retrospective chart review study of these adults seen at an urban academic rehabilitation clinic and who underwent DXA scan(s). BMD and Z-scores for the lumbar spine, hips, and femoral (neck and total) were recorded. The change in BMD and Z-scores from baseline to follow-up DEXA, Gross Motor Functional Classification System (GMFCS), CP pattern (hemiplegic, diplegic, or quadriplegic), body mass index (BMI), and transfer and ambulation status were assessed.
Forty-two patients (83 % less than age 50 years) had at least one DXA. Seventeen had at least two studies, 15 without pharmacologic interventions between studies. Thirteen fractures in eight subjects were noted, most often lower limb. Fifty percent of spine studies in individuals under 50 had a Z-score of less than -2, while 25 and 30.8 % of these individuals had such scores at the right and left total hip sites, respectively. Need for transfer assistance was associated with lower BMD and Z-scores at all hip sites, but not the lumbar spine. Progressive abnormalities were seen at follow-up DXAs at some sites, however these were not statistically significant.
Lower than expected-for-age BMD was very frequent in adults with CP with mobility limitations, present at both spine and hip sites. Low BMI and need for transfer assistance had a negative impact on BMD. Although not statistically significant, progression of abnormalities was seen at follow-up for DXAs Z-scores at some sites, which suggests longitudinal studies in this population are needed.
本研究旨在描述成人脑瘫（CP）患者的骨质疏松症筛查情况，并确定任何相关因素。这些成人的骨密度（BMD）通常低于同龄人预期水平，甚至在青年期就已出现，尤其是在脊柱部位。成人CP患者中低骨密度很常见。
本研究旨在描述双能X线吸收法（DXA）筛查成人脑瘫（CP）患者的可行性，并确定与低骨密度（BMD）相关的因素，包括纵向变化。
对在城市学术康复诊所就诊并接受DXA扫描的这些成人进行回顾性病历审查研究。记录腰椎、髋部和股骨（颈和全段）的骨密度和Z值。评估从基线到随访DXA时骨密度和Z值的变化、粗大运动功能分级系统（GMFCS）、CP类型（偏瘫、双瘫或四肢瘫）、体重指数（BMI）以及转移和行走状态。
42例患者（83%年龄小于50岁）至少进行了一次DXA检查。17例患者至少进行了两次检查，其中15例在两次检查之间未接受药物干预。8名受试者出现13处骨折，最常见于下肢。50%年龄小于50岁个体的脊柱检查Z值小于-2，而这些个体中分别有25%和30.8%在右侧和左侧全髋部位有此类Z值。需要转移辅助与所有髋部部位较低的骨密度和Z值相关，但与腰椎无关。在一些部位的随访DXA检查中发现有进展性异常，然而这些差异无统计学意义。
在有行动障碍的成人CP患者中，低于同龄人预期水平的骨密度非常常见，在脊柱和髋部部位均有出现。低BMI和需要转移辅助对骨密度有负面影响。尽管差异无统计学意义，但在一些部位随访DXA检查的Z值有异常进展，这表明需要对该人群进行纵向研究。
