Pediatric Physical Medicine and Rehabilitation Center, Amiens University Hospital, 80000, Amiens, France.
MP3CV‑EA7517, CURS, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France.
Osteoporos Int. 2022 Sep;33(9):2019-2025. doi: 10.1007/s00198-022-06436-5. Epub 2022 May 26.
Children with severe cerebral palsy are prone to low bone mineral density. No clear recommendation exists for an optimal use of standing frame to enhance bone health in this context. Used in real life, this study suggests for the first time that standing practice improved bone mineralization by limiting bone resorption.
To compare the bone health of children with severe cerebral palsy who use a static standing frame in real life to that of children who do not.
A total of 24 children with severe cerebral palsy GMFCS IV & V were included in the study and were divided into two groups: 13 were using a passive standing frame and 11 were not. We performed a single center retrospective cross-sectional study comparing the two groups using dual X-ray absorptiometry data and tests on biological samples, including bone remodeling factors.
Total body (less head) bone mineral content was significantly higher in children who used a standing frame for an average of 30 min/day. This was confirmed in the lumbar spine. Although the total body bone mineral density (less head and proximal femur) densitometric data were not significantly higher, a positive trend favored the use of a standing frame in the children. Bone resorptive factors (CTX) were higher in the non-standing-frame group, whereas there was no difference among osteoformation factors. No difference in fracture history was found.
We show that non-ambulant children with cerebral palsy who use a static standing frame in real life have better bone health, with lower bone resorption, than children who do not. Further studies are needed to determine how standing practice could impact bone mineralization over time in real life and to explore more bone remodeling factors.
严重脑瘫儿童易出现低骨密度。目前尚不清楚最佳使用站立架来增强此类患者骨骼健康的方法。本研究在现实生活中首次发现，使用站立架可通过限制骨吸收来改善骨矿化。
比较严重脑瘫儿童在现实生活中使用静态站立架与不使用站立架对其骨骼健康的影响。
本研究共纳入 24 例严重脑瘫（GMFCS IV 和 V 级）儿童，分为两组：使用被动站立架 13 例，未使用站立架 11 例。我们进行了一项单中心回顾性交叉研究，通过双能 X 线吸收法和生物样本检测（包括骨重塑因子）比较两组数据。
每天平均使用站立架 30 分钟的儿童，其全身（不包括头部）骨矿物质含量显著更高。腰椎骨也有同样的结果。虽然全身骨密度（不包括头部和股骨近端）的密度数据无显著差异，但站立架组有更高的正趋势。不使用站立架组的骨吸收因子（CTX）更高，而成骨因子无差异。两组骨折史无差异。
我们发现，在现实生活中使用静态站立架的非步行脑瘫儿童，其骨吸收较低，骨骼健康状况优于不使用站立架的儿童。需要进一步研究来确定在现实生活中，站立练习对骨矿化的长期影响，并探索更多的骨重塑因子。
