Systematic review of interventions for low bone mineral density in children with cerebral palsy
AIM: To systematically review the efficacy of interventions to improve low bone mineral density (LBMD) in children and adolescents with cerebral palsy (CP). METHODS: We performed a systematic search for published randomized, controlled trials (RCTs) and controlled clinical trials (CCTs) of children...
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| Format: | Journal Article |
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American Academy of Pediatrics
2010
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| Online Access: | http://hdl.handle.net/20.500.11937/12150 |
| _version_ | 1848747998155112448 |
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| author | Hough, J. Boyd, Roslyn Keating, J. |
| author_facet | Hough, J. Boyd, Roslyn Keating, J. |
| author_sort | Hough, J. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | AIM: To systematically review the efficacy of interventions to improve low bone mineral density (LBMD) in children and adolescents with cerebral palsy (CP). METHODS: We performed a systematic search for published randomized, controlled trials (RCTs) and controlled clinical trials (CCTs) of children with CP (aged 0-20 years, all Gross Motor Function Classification System [GMFCS] levels) who received various medical and physical interventions for LBMD compared with no intervention or standard care. Study validity was evaluated by using the Physiotherapy Evidence Database (PEDro) scale. Standardized mean differences (SMDs) were calculated when data were sufficient. RESULTS: Eight of 2034 articles met the inclusion criteria (6 RCTs, 2 CCTs). There were 3 trials of bisphosphonates, one of which (Henderson RC, Lark RK, Kecskemethy HH, Miller F, Harcke HT, Bachrach SJ. J Pediatr. 2002;141[5]:644-651) revealed a large and significant effect on BMD in 1 of 3 sites in the distal femur (SMD: 1.88 [95% confidence interval (CI): 0.52-3.24]). There were 3 trials of weight-bearing through varying approaches, one of which (Caulton JM, Ward KA, Alsop CW, Dunn G, Adams JE, Mughal MZ. Arch Dis Child. 2004;89[2]:131-135) showed a large and significant effect on the lumbar spine when increasing static standing time (SMD: 1.03 [95% CI: 0.21-1.85]). The administration of vitamin D and calcium produced a large, nonsignificant effect on BMD in the lumbar spine (Jekovec-Vrhovsek M, Kocijancic A, Prezelj J. Dev Med Child Neurol. 2000;42[6]:403-405) (SMD: 0.88 [95% CI: - 0.07 to 1.84). Growth hormone combined with vitamin D and/or calcium resulted in effects comparable with vitamin D and/or calcium on BMD in the lumbar spine (Ali O, Shim M, Fowler E, et al. J Clin Endocrinol Metab. 2007;92[3]:932-937) (SMD 0 [95% CI: - 1.24 to 1.24]). CONCLUSIONS: Important effects on LBMD have been observed in small and diverse cohorts of children with CP. It is unclear whether small sample sizes or variable treatment responses account for nonsignificant findings. Additional large RCTs are needed of both physical and medical approaches. Copyright © 2010 by the American Academy of Pediatrics. |
| first_indexed | 2025-11-14T06:58:03Z |
| format | Journal Article |
| id | curtin-20.500.11937-12150 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T06:58:03Z |
| publishDate | 2010 |
| publisher | American Academy of Pediatrics |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-121502017-09-13T14:56:51Z Systematic review of interventions for low bone mineral density in children with cerebral palsy Hough, J. Boyd, Roslyn Keating, J. AIM: To systematically review the efficacy of interventions to improve low bone mineral density (LBMD) in children and adolescents with cerebral palsy (CP). METHODS: We performed a systematic search for published randomized, controlled trials (RCTs) and controlled clinical trials (CCTs) of children with CP (aged 0-20 years, all Gross Motor Function Classification System [GMFCS] levels) who received various medical and physical interventions for LBMD compared with no intervention or standard care. Study validity was evaluated by using the Physiotherapy Evidence Database (PEDro) scale. Standardized mean differences (SMDs) were calculated when data were sufficient. RESULTS: Eight of 2034 articles met the inclusion criteria (6 RCTs, 2 CCTs). There were 3 trials of bisphosphonates, one of which (Henderson RC, Lark RK, Kecskemethy HH, Miller F, Harcke HT, Bachrach SJ. J Pediatr. 2002;141[5]:644-651) revealed a large and significant effect on BMD in 1 of 3 sites in the distal femur (SMD: 1.88 [95% confidence interval (CI): 0.52-3.24]). There were 3 trials of weight-bearing through varying approaches, one of which (Caulton JM, Ward KA, Alsop CW, Dunn G, Adams JE, Mughal MZ. Arch Dis Child. 2004;89[2]:131-135) showed a large and significant effect on the lumbar spine when increasing static standing time (SMD: 1.03 [95% CI: 0.21-1.85]). The administration of vitamin D and calcium produced a large, nonsignificant effect on BMD in the lumbar spine (Jekovec-Vrhovsek M, Kocijancic A, Prezelj J. Dev Med Child Neurol. 2000;42[6]:403-405) (SMD: 0.88 [95% CI: - 0.07 to 1.84). Growth hormone combined with vitamin D and/or calcium resulted in effects comparable with vitamin D and/or calcium on BMD in the lumbar spine (Ali O, Shim M, Fowler E, et al. J Clin Endocrinol Metab. 2007;92[3]:932-937) (SMD 0 [95% CI: - 1.24 to 1.24]). CONCLUSIONS: Important effects on LBMD have been observed in small and diverse cohorts of children with CP. It is unclear whether small sample sizes or variable treatment responses account for nonsignificant findings. Additional large RCTs are needed of both physical and medical approaches. Copyright © 2010 by the American Academy of Pediatrics. 2010 Journal Article http://hdl.handle.net/20.500.11937/12150 10.1542/peds.2009-0292 American Academy of Pediatrics restricted |
| spellingShingle | Hough, J. Boyd, Roslyn Keating, J. Systematic review of interventions for low bone mineral density in children with cerebral palsy |
| title | Systematic review of interventions for low bone mineral density in children with cerebral palsy |
| title_full | Systematic review of interventions for low bone mineral density in children with cerebral palsy |
| title_fullStr | Systematic review of interventions for low bone mineral density in children with cerebral palsy |
| title_full_unstemmed | Systematic review of interventions for low bone mineral density in children with cerebral palsy |
| title_short | Systematic review of interventions for low bone mineral density in children with cerebral palsy |
| title_sort | systematic review of interventions for low bone mineral density in children with cerebral palsy |
| url | http://hdl.handle.net/20.500.11937/12150 |