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A 9-year-old girl with non-ambulant cerebral palsy (Gross Motor Function Classification Scale (GMFCS) level 4) attends clinic. Despite adequate calcium and vitamin D supplementation, a recent dual-energy x-ray absortiometry (DEXA) bone scan shows a bone mineral density in the osteopenic range (Z score −2.6). Her mother is anxious about the risk of fractures and asks what can be done to reduce the risk.
Structured clinical question
In children with osteopenia secondary to cerebral palsy, do weight-bearing activities (including standing frames, vibration platforms and physiotherapy) reduce the risk of fractures?
A PubMed search using MeSH terms bone density AND cerebral palsy AND physi* gave 26 results. A wider search of MEDLINE, Cochrane and Trip databases was searched for the terms (‘cerebral palsy’) AND (‘physical therapy’ OR ‘vibration’ OR ‘physiotherapy’ OR ‘passive standing’ OR ‘dynamic standing’) AND (‘fracture’ OR ‘bone density’). Fifty-six results were found. No appropriate papers were found on Cochrane review. Nine papers were assessed and included.⇓
Children and adolescents with cerebral palsy are prone to fragility fractures …
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