Trinh Anne, Wong Phillip, Fahey Michael C, Brown Justin, Strauss Boyd J, Ebeling Peter R, Fuller Peter J, Milat Frances
Department of Endocrinology, Monash Health, Melbourne, Victoria, Australia.
Hudson Institute of Medical Research, Melbourne, Victoria, Australia.
Clin Endocrinol (Oxf). 2019 Oct;91(4):517-524. doi: 10.1111/cen.14052. Epub 2019 Jul 10.
Cerebral palsy (CP) is a motor disorder affecting movement, muscle tone and posture due to damage to the foetal or infant brain. The subsequent lack of ambulation, nutritional deficiencies, anticonvulsant use and hormonal deficiencies have been implicated in the low bone mass associated with this condition.
To assess changes in areal bone mineral density (aBMD) during adolescence and young adulthood in individuals with CP. The effect of ambulation, nutrition, hypogonadism on longitudinal changes in aBMD is also examined.
Retrospective longitudinal study.
Forty-five subjects with CP who had longitudinal dual-energy X-ray absorptiometry (DXA) scans at a single tertiary hospital between 2006 and 2018.
Mean age at first DXA was 19.4 years (range: 10-36 years), 57.8% were male and 80% were nonambulatory. The mean Z-scores at baseline were <-2.0 at all sites - lumbar spine (LS), femoral neck (FN), total hip (TH) and total body (TB). The median change in aBMD was +1.2%-1.9% per year in all subjects but in those <20 years of age, the median change was 4%-8% per year. Z-scores across all sites remained stable over time. Reduced functional state as measured by the gross motor functional classification scale (GMFCS) had a small negative effect on aBMD over time.
In adolescents with CP, low bone mass was evident from the baseline DXA. However, significant bone accrual occurred during the second decade, followed by bone maintenance in young adulthood. Future studies should focus on optimizing bone health from early childhood.
脑性瘫痪（CP）是一种运动障碍，因胎儿或婴儿脑部受损而影响运动、肌张力和姿势。随后出现的无法行走、营养缺乏、使用抗惊厥药物以及激素缺乏等情况，都与该病症相关的低骨量有关。
评估脑性瘫痪患者在青春期和青年期骨面积密度（aBMD）的变化。同时研究行走能力、营养状况、性腺功能减退对aBMD纵向变化的影响。
回顾性纵向研究。
45名脑性瘫痪患者，于2006年至2018年期间在一家三级医院接受了纵向双能X线吸收法（DXA）扫描。
首次DXA检查时的平均年龄为19.4岁（范围：10 - 36岁），57.8%为男性，80%无法行走。所有部位（腰椎、股骨颈、全髋和全身）基线时的平均Z值均＜ - 2.0。所有受试者的aBMD中位数每年变化为 + 1.2% - 1.9%，但年龄＜20岁的受试者，中位数每年变化为4% - 8%。所有部位的Z值随时间保持稳定。通过粗大运动功能分级量表（GMFCS）测量的功能状态降低，随着时间推移对aBMD有较小的负面影响。
在患有脑性瘫痪的青少年中，从基线DXA检查就可明显看出骨量较低。然而，在第二个十年期间出现了显著的骨质积累，随后在青年期骨质保持稳定。未来的研究应侧重于从幼儿期开始优化骨骼健康。
