Article

The aim of this systematic review was to inform evidence-based clinical
practice guidelines for children with cerebral palsy (CP) and low bone mineral density (BMD). METHOD: A computer-assisted literature search was focused on low BMD in children with CP, and was limited to the following interventions:
weight-bearing activities, bisphosphonate use,
and vitamin D or calcium
supplementation. Articles were classified according to American Academy of
Neurology guidelines and recommendation classifications were given based on the
evidence for the intervention increasing BMD and decreasing fragility fractures.
Studies were included if they were English-language full-text studies, focused on
children with CP, and included at least 10 participants receiving the studied
interventions. RESULTS: Twenty-one articles underwent full-text review and data
abstraction, including seven studies of weight-bearing activities, five studies
of vitamin D or calcium supplementation, and nine studies of bisphosphonates
administration. Overall, the evidence that bisphosphonates administration
increases BMD was assessed as level B (probable) while the evidence that vitamin
D or calcium supplementation does so was assessed as level C (possible); there
was insufficient evidence to suggest that weight-bearing activities are an
effective intervention to improve BMD. The evidence that bisphosphonates help to
prevent fragility fractures was assessed as level C (possible); there was
inadequate evidence to support the use of weight-bearing activities or vitamin D
or calcium supplementation to decrease fragility fractures. INTERPRETATION:
Evidence-based clinical practice guidelines were created outlining the suggested
role of weight-bearing activities, vitamin D and calcium supplementation, and
bisphosphonate use for children with CP with low BMD at risk of fragility fractures.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2011 Mac Keith
Press.

Langue : ANGLAIS