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Vojnosanitetski pregled
2019, vol. 76, iss. 5, pp. 485-491
article language: English
document type: Original Paper
Creative Commons License 4.0
Bone mineral density in comparison to the anthropometric parameters and level of gross motor function in children with cerebral palsy
aUniversity of Novi Sad, Faculty of Medicine, Novi Sad + Special Hospital for Rheumatic Diseases, Novi Sad
bUniversity of Novi Sad, Faculty of Medicine, Novi Sad + Institute of Child and Youth Health Care of Vojvodina, Novi Sad
cUniversity of Novi Sad, Faculty of Medicine, Novi Sad + Home "Veternik", Veternik
dHealth Center "Novi Sad", Novi Sad



Background/Aim. Children with cerebral palsy (CP) grow at a slower rate relative to their peers. Their body height, body weight and bone mineral density are significantly below those measured for healthy children of corresponding age. The aim of this work was to estimate bone mineral density in relation to the anthropometric parameters and the level of gross motor function in the children with cerebral palsy. Methods. This cross-sectional pilot study included 23 children with CP, aged 6 to 17 years, in whom the gross motor function level was estimated according to the Gross motor function classification system-expanded and revised (GMFCS-E&R), while the anthropometric parameters were established in relation to the developmental charts for healthy children as well as those pertaining to children with CP. Bone mineral density was measured by dual energy X-ray absorptiometry and the findings were interpreted in accordance with the International Society for Clinical Densitometry Official Positions of Adults & Pediatrics. Mean values with interquartile deviations, along with frequencies and percentages were the descriptive statistical measures employed in the analyses. Differences between groups were ascertained through the Kruskal-Wallis test. Results. Our sample of 23 children comprised of 56.5% boys and 43.5% girls, aged 13.00 ± 3.56 years, of whom 3/4 had a severe form of gross motor dysfunction (GMFCS-E&R levels IV and V). All subjects had lower bone density in both regions of interest [spinal Z-score -1.60 ± 1.40 standard deviation (SD); hip Z-score -2.00 ± 3.00 SD], as well as lower anthropometric parameters [height Z-score -2.74 ± 4.28; body weight Z-score - 3.22 ± 6.96; body mass index (BMI) Z-score -2.64 ± 6.03]. In the observed sample, bone mineral density in the spine (p < 0.01) and the hip (p < 0.05) was reduced in all subjects, and all children had a lower body weight (p < 0.01) and the BMI (p < 0.01), but not body height, in relation to the existing developmental charts for the CP children adopted from the US. Children with the CP Level IV on the GMFCS-E&R had a significantly lower bone density (spinal Z-score -1.90 SD; hip Z-score -3.40 SD), with the reduction even more pronounced at level V (spinal Z-score -3.80 SD; hip Z-score -2.30 SD). Conclusion. A significantly lower bone mineral density as well as the decreased values of all observed anthropometric parameters, were noted in the children with CP. In the observed sample, bone mineral density in both spine and hip was reduced in all subjects, all of whom also had lower body weight and the BMI, but not body height compared to the existing developmental charts for the children with CP adopted from the US. The children with severe forms of CP (GMFCS-E&R levels IV and V) had significantly lower bone mineral density.



*** New Growth Charts: Life Expectancy for CP, vs, TBI and SCI. Available from:
Aggarwal, S., Chadha, R., Pathak, R. (2015) Nutritional status and growth in children with cerebral palsy: A review. International Journal of Medical Science and Public Health, 4(6): 737-737
Barlow, S.E. (2007) Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. Pediatrics, 120(Supplement 4): S164-S192
Bax, M., Goldstein, M., Rosenbaum, P., Leviton, A., Paneth, N., Dan, B., Jacobsson, B., Damiano, D. (2005) Proposed definition and classification of cerebral palsy, April 2005. Developmental Medicine & Child Neurology, 47(8): 571-576
Bell, K.L., Davies, P.S. (2010) Energy expenditure and physical activity of ambulatory children with cerebral palsy and of typically developing children 1-3. American Journal of Clinical Nutrition, 92(2): 313-319
Bowdena, S., Jessup, A., Akusoba, C., Mahan, J. (2015) Zoledronic Acid in Non-Ambulatory Children and Young Adults with Fragility Fractures and Low Bone Mass Associated with Spastic Quadriplegic Cerebral Palsy and Other Neuromuscular Disorders. Journal of Endocrinology and Diabetes Mellitus, 3(2): 35-41
Brooks, J., Day, S., Shavelle, R., Strauss, D. (2011) Low Weight, Morbidity, and Mortality in Children with Cerebral Palsy: New Clinical Growth Charts. Pediatrics, 128(2): e299-e307
Centers for Disease Control and Prevention (CDC) (2000) Growth charts. Available from:
Coppola, G., Fortunato, D., Auricchio, G., Mainolfi, C., Operto, F.F., Signoriello, G., Pascotto, A., Salvatore, M. (2009) Bone mineral density in children, adolescents, and young adults with epilepsy. Epilepsia, 50(9): 2140-2146
Dahlseng, M.O., Finbråten, A., Júlíusson, P.B., Skranes, J., Andersen, G., Vik, T. (2012) Feeding problems, growth and nutritional status in children with cerebral palsy. Acta Paediatrica, 101(1): 92-98
Day, S.M. (2010) Improving growth charts for children and adolescents with cerebral palsy through evidence-based clinical practice. Developmental Medicine & Child Neurology, 52(9): 793-793
Day, S.M., Strauss, D.J., Vachon, P.J., Rosenbloom, L., Shavelle, R.M., Wu, Y.W. (2007) Growth patterns in a population of children and adolescents with cerebral palsy. Developmental Medicine & Child Neurology, 49(3): 167-171
Feeley, B.T., Gollapudi, K., Otsuka, N.Y. (2007) Body mass index in ambulatory cerebral palsy patients. Journal of Pediatric Orthopaedics B, 16(3): 165-169
Fung, E.B., Samson-Fang, L., Stallings, V.A., Conaway, M., Liptak, G., Henderson, R.C., Worley, G., Calvert, R., Rosenbaum, P., Chumlea, W., Stevenson, R.D. (2002) Feeding Dysfunction is Associated with Poor Growth and Health Status in Children with Cerebral Palsy. Journal of the American Dietetic Association, 102(3): 361-373
Gordon, C.M., Bachrach, L.K., Carpenter, T.O., Crabtree, N., El-Hajj, F.G., Kutilek, S., Lorenc, R.S., Tosi, L.L., Ward, K.A., Ward, L.M., Kalkwarf, H.J. (2008) Dual Energy X-ray Absorptiometry Interpretation and Reporting in Children and Adolescents: The 2007 ISCD Pediatric Official Positions. Journal of Clinical Densitometry, 11(1): 43-58
Henderson, R.C., Lark, R.K., Gurka, M.J., Worley, G., Fung, E.B., Conaway, M., Stallings, V.A., Stevenson, R.D. (2002) Bone Density and Metabolism in Children and Adolescents with Moderate to Severe Cerebral Palsy. Pediatrics, 110(1): e5-e5
Henderson, R.C., Berglund, L.M., May, R., Zemel, B.S., Grossberg, R.I., Johnson, J., Plotkin, H., Stevenson, R.D., Szalay, E., Wong, B., Kecskemethy, H.H., Harcke, T.H. (2010) The relationship between fractures and DXA measures of BMD in the distal femur of children and adolescents with cerebral palsy or muscular dystrophy. Journal of Bone and Mineral Research, 25(3): 520-526
Houlihan, C.M., Stevenson, R.D. (2009) Bone Density in Cerebral Palsy. Physical Medicine and Rehabilitation Clinics of North America, 20(3): 493-508
Jelić, Đ., Stefanović, D., Petronijević, M., Anđelić-Jelić, M. (2008) Why dual X-ray absorptiometry is the gold standard in diagnosing osteoporosis. Vojnosanitetski pregled, vol. 65, br. 12, str. 919-922
Karagiozoglou-Lampoudi, T., Daskalou, E., Vargiami, E., Zafeiriou, D. (2012) Identification of feeding risk factors for impaired nutrition status in paediatric patients with cerebral palsy. Acta Paediatrica, 101(6): 649-654
Krick, J., Murphy-Miller, P., Zeger, S., Weight, E. (1996) Pattern of Growth in Children with Cerebral Palsy. Journal of the American Dietetic Association, 96(7): 680-685
Kuczmarski, R.J., Ogden, C.L., Grummer-Strawn, L.M., Flegal, K.M., Guo, S.S., Wei, R., i dr. (2000) CDC growth charts: United States. Adv Data, 314): 127-127
Kuperminc, M.N., Stevenson, R.D. (2008) Growth and nutrition disorders in children with cerebral palsy. Developmental Disabilities Research Reviews, 14(2): 137-146
Marchand, V. (2009) Nutrition in neurologically impaired children. Paediatrics and Child Health, 14(6): 395401-395401
Mejaški-Bošnjak, V. (2007) Neurological syndromes in infancy and cerebral palsy. Paediatr Croat
Palisano, R., Rosenbaum, P., Bartlett, D., Livingston, M. Gross Motor Function Classification System: Expanded & Revised (GMFCS-E & R). Available from:
Palisano, R., Rosenbaum, P., Walter, S., Russell, D., Wood, E., Galuppi, B. (1997) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine & Child Neurology, 39(4): 214-223
Rosenbaum, P., Paneth, N., Leviton, A., Goldstein, M., Bax, M., Damiano, D., i dr. (2007) A report: The definition and classification of cerebral palsy: April 2006. Dev Med Child Neurol Suppl, 109: 814-814
Şimşek, T.T., Tuç, G. (2014) Examination of the relation between body mass index, functional level and health-related quality of life in children with cerebral palsy. Turk Pediatri Ars, 49(2): 1307-1307
Stevenson, R.D., Conaway, M., Chumlea, W.C., Rosenbaum, P., Fung, E.B., Henderson, R.C., Worley, G., Liptak, G., Samson-Fang, L., Stallings, V.A. (2006) Growth and Health in Children with Moderate-to-Severe Cerebral Palsy. Pediatrics, 118(3): 1010-1018
Worley, G., Houlihan, C.M., Herman-Giddens, M.E., Conaway, M., Stallings, V.A., Chumlea, W.C., Henderson, R.C., Fung, E.B., Rosenbaum, P.L., Samson-Fang, L., Liptak, G.S., Calvert, R.E., Stevenson, R.D. (2002) Secondary Sexual Characteristics in Children with Cerebral Palsy and Moderate to Severe Motor Impairment: A Cross-Sectional Survey. Pediatrics, 110(5): 897-902
Wren, T.Al., Lee, D.C., Kay, R.M., Dorey, F.J., Gilsanz, V. (2011) Bone density and size in ambulatory children with cerebral palsy. Developmental Medicine & Child Neurology, 53(2): 137-141
Zemel, B.S., Stallings, V.A., Leonard, M.B., Paulhamus, D.R., Kecskemethy, H.H., Harcke, H., Henderson, R.C. (2009) Revised Pediatric Reference Data for the Lateral Distal Femur Measured by Hologic Discovery/Delphi Dual-Energy X-Ray Absorptiometry. Journal of Clinical Densitometry, 12(2): 207-218