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Question 2: Do standing frames and other related physical therapies reduce the risk of fractures in children with cerebral palsy?
  1. Sarah Whittaker1,
  2. Richard Tomlinson2
  1. 1 Peninsula Medical School, Exeter, UK
  2. 2 Department of Child Health, Royal Devon & Exeter Hospital NHS Trust, Exeter, UK
  1. Correspondence to Dr Richard Tomlinson, Department of Child Health, Royal Devon & Exeter Hospital NHS Trust, Barrack Road, Exeter EX2 5DW, UK; Richard.tomlinson{at}

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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?

Search strategy

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.

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Table 1


Children and adolescents with cerebral palsy are prone to fragility fractures …

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  • Contributors Both authors contributed equally.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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