Prevalence of and risk factors for osteoporosis and fragility fracture in adults with cerebral palsy: A systematic review
Prepared by: AACPDM Digest reviewer/Cherlyn Caneda MSN, CPNP
Keywords:
- Cerebral palsy
- Osteoporosis
- Incidence
- Prevalence
- Risk Factors
- Fracture
Study Type: Systematic Literature Review
Summary: Osteoporosis and fractures are well-recognized medical issues faced by children and adolescents with Cerebral Palsy (CP). As life expectancy for individuals with CP increases, the risk of osteoporosis and fractures grows, driven by childhood risk factors and compounded by age-related bone loss. This systematic review aimed to evaluate the prevalence and incidence of osteoporosis, osteopenia, low bone mass, and fragility fractures in adults with CP, as well as identify associated risk factors. The review searched multiple databases, including MEDLINE, PubMed, CINAHL, AMED, Cochrane Reviews, EMBASE, and EBM, focusing on studies involving adults aged 18 and older with CP.
Of the 303 studies reviewed for osteoporosis and fracture prevalence and incidence, 17 met the eligibility criteria; 16 of 663 studies were included for assessing risk factors. Findings revealed that fragility fractures were more common in older, female, and non-ambulatory individuals with CP. Osteoporosis prevalence was found to be 5% in the general adult CP population, rising to 43% in those attending outpatient clinics. One study reported an osteoporosis incidence rate of 2.85 per 1,000 person-years. Fragility fractures had an overall prevalence of 5.5%, but this increased to 38% in outpatient settings.
Risk factors for osteoporosis and low bone density were similar to those in childhood and included a high GMFCS level, non-ambulatory status, enteral feeding, low BMI, hypogonadism, and anticonvulsant medication use. The study emphasizes the importance of recognizing the prevalence and risk factors for osteoporosis and fractures to guide early screening and management. Addressing these issues is crucial to prevent complications such as loss of independence, reduced mobility, and pain, improving long-term health outcomes for adults with CP.