Managing Bone Fragility in the Child with Cerebral Palsy

Skeletal health during the childhood years has a direct effect on lifetime risk of osteoporosis and bone fragility. Children with cerebral palsy (CP) frequently have comorbidities that influence bone development and health. With increased severity of the CP, there are greater systemic effects on body systems and commensurate deleterious effects on bone. These comorbidities may include nutritional deficiencies, limited or no weight bearing, use of various medications that affect bone, and lack of exposure to sunlight. The presence of these comorbidities has a direct effect on bone health, which results in decreased bone mineral density and puts many of these children at risk for fragility fractures. In this chapter, we will review the natural history of CP and the basics of bone formation, discuss assessment of bone health for children with CP including measurement of bone density, and present current treatment practices for children with compromised bone health.