BONE-MINERAL DENSITY IN CHILDREN AND ADOLESCENTS WHO HAVE SPASTIC CEREBRAL-PALSY

Bone-mineral density was studied in a heterogeneous group of 139 child ren (mean age, nine years; range, three to fifteen years) who had spas tic cerebral palsy, The evaluation included serum analyses and a nutri tional assessment based on a dietary history and anthropometric measur ements. The bone-mineral density of the proximal parts of the femora a nd the lumbar spine was measured with dual-energy x-ray absorptiometry and was normalized for age against a series of ninety-five normal chi ldren and adolescents who served as controls, Bone-mineral density var ied greatly but averaged nearly one standard deviation below the age-m atched normal means for both the proximal parts of the femora (-0.92 s tandard deviation) and the lumbar spine (-0.80 standard deviation), Am bulatory status was the factor that best correlated with bone-mineral density, Nutritional status, assessed on the basis of caloric intake, skinfolds, and body-mass index, was the second most significant variab le, The pattern of involvement, durations of immobilization in a cast, and a calcium intake of less than 500 milligrams per day were additio nal factors of less significance, The age when the child first walked, previous fractures, use of anticonvulsants, and serum vitamin-D level s did not correlate with bone-mineral density after adjustment for cov ariance with the ambulatory status and the nutritional status, Serum l evels of calcium, phosphate, alkaline phosphatase, and osteocalcin wer e not reliable indicators of low bone-mineral density.