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    Systematic review of interventions for low bone mineral density in children with cerebral palsy

    Access Status
    Fulltext not available
    Authors
    Hough, J.
    Boyd, Roslyn
    Keating, J.
    Date
    2010
    Type
    Journal Article
    
    Metadata
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    Citation
    Hough, J. and Boyd, R. and Keating, J. 2010. Systematic review of interventions for low bone mineral density in children with cerebral palsy. Pediatrics. 125 (3): pp. e670-e678.
    Source Title
    Pediatrics
    DOI
    10.1542/peds.2009-0292
    ISSN
    0031-4005
    School
    School of Occupational Therapy and Social Work
    URI
    http://hdl.handle.net/20.500.11937/12150
    Collection
    • Curtin Research Publications
    Abstract

    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.

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