Assessment of BMD following Bisphosphonate in Pre- and Postpubertal Children with Cerebral Palsy
Board Location: #84
Discipline: Biological Sciences
Subcategory: physiology and health science
Session: 2
Chanelle Adjei - University of Delaware
Co-Author(s): Laura Owens, Nemours Children's Hospital, DE; Heidi Kecskemethy, Nemours Children’s Hospital, DE
Problem:
Non-ambulatory children with cerebral palsy (CP) are high risk for low bone mineral density (BMD) and fractures due to limited weight bearing and poor nutrition¹. Bisphosphonates (BP) are commonly used to improve BMD, preventing fractures by inhibiting bone breakdown. Little is known about how BP impacts BMD throughout development in children with CP, specifically before and after puberty². Bones rapidly grow during childhood, and puberty onset marks the end of growth. Therefore we anticipate differing response rates in BMD to BP during and after treatment in prepubescent children with CP compared to postpubescent peers.
Methods:
IRB-approved retrospective medical record review of patients aged 2 – 18 years seen at our children’s hospital from 2000 to 2025. BMD results at the lateral distal femur (LDF) DXA site were evaluated for children with CP (GMFCS IV or V) and received BP for at least 1 year. Patients were grouped by Tanner score during treatment: prepubescent (Tanner 1-2) and postpubescent (Tanner 3-5). Patients who changed Tanner groups during treatment were excluded. LDF DXA R1 and R3 BMD values were evaluated from the limb with the most complete data; when available bilaterally, BMD was averaged. Annual percent change in BMD during and after treatment was calculated for pre- and postpubescent groups by region, data normality was assessed, and non-paired t-tests were performed.
Results and Discussion:
Thirteen children (7 females) with a mean age of 11.6 years (range 4.3 -18.5) at time of first BP treatment were included. Six were prepubescent; 7 were postpubescent. Total observation time was 62 years (4.8 person years). During BP treatment, both groups showed an increase in LDF R1 BMD with a significantly greater increase of BMD in the prepubescent group (p = 0.0156). After BP discontinuation, prepubescent children showed a greater loss of BMD at R1 (p=0.0076), while BMD in postpubescent children was maintained. R1 is adjacent to the metabolically active growth plate. R3 (primarily cortical bone) BMD responses to BP were not significantly different between groups though a trend of greater BMD increase was seen in postpubescents.
Conclusions, and Future Research:
BP was effective at increasing BMD in all children with CP. Differences were seen in BMD response to BP based on stage of puberty and location of bone. Prepubescents had greater response to both treatment and discontinuation at the LDF R1 DXA site, while response was varied at the cortical R3 site. This work supports the need for a prospective study with a clear drug and DXA schedule to provide better evidence for optimization of BP.
References:
Hodgson E, et al. Smaller and thinner long bones in children and adolescents with cerebral palsy and other neuromotor impairments. Front Endocrinol. Lausanne. 2025
Granild-Jensen JB, et al. Cerebral palsy and bisphosphonates – and what can be learned from other types of secondary osteoporosis in children. Acta Paed
Funder Acknowledgement(s): This research was supported by the Delaware INBRE program, with a grant from the National Institute of General Medical Sciences - NIGMS (P20 GM103446) from the National Institutes of Health & the State of Delaware.
Faculty Advisor: Laura Owens; Heidi Kecskemethy, LauraOwensLaura.Owens@nemours.orgHeidiKecskemethyHeidi.Kecskemethynemours.org
Role: This past summer I, Chanelle Adjei, was responsible for clinical research conducted at Nemours Children's Hospital on Bone Health in pediatric populations with Cerebral Palsy. During my time I updated our RedCap databases. I was then responsible for creating and refining a research question after multiple literature reviews, defining and assessing our study cohort, compiling data, aiding in the statistical testing, and presenting our findings at the end of the summer. All research was conducted under the guidance of my mentors.