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Informing evidence‐based clinical practice guidelines for children with cerebral palsy at risk of osteoporosis: an update
Author(s) -
Ozel Sezgi,
Switzer Lauren,
Macintosh Alex,
Fehlings Darcy
Publication year - 2016
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.13196
Subject(s) - cerebral palsy , vitamin d and neurology , medicine , osteoporosis , bisphosphonate , physical therapy , psychological intervention , pediatrics , bone mineral , psychiatry
Aim To investigate the impact of new evidence for weight‐bearing, bisphosphonates, and vitamin D and calcium interventions, towards updating the systematic review and clinical practice guidelines for osteoporosis in children with cerebral palsy (CP) published in 2011. Method Computer‐assisted literature searches were conducted for articles published from 2010 to 2016. Searches focused on children with CP functioning at Gross Motor Function Classification System levels III to V and limited to weight‐bearing activities, bisphosphonates, and vitamin D and/or calcium supplementation. Articles were classified according to the American Academy of Neurology guidelines to update the grading of the evidence for improving bone mineral density (BMD) and decreasing fragility fractures. Results Six new articles underwent full‐text review and data abstraction. These included one weight‐bearing, three bisphosphonate, and two mixed intervention studies (bisphosphonate and vitamin D/calcium supplementation). Overall, there continues to be ‘probable’ evidence for bisphosphonates, ‘possible’ evidence for vitamin D/calcium, and ‘insufficient’ evidence for weight‐bearing activities as effective interventions to improve low BMD in children with CP. There is ‘possible’ evidence for bisphosphonates in reducing fragility fractures. Interpretation The grading of evidence to support the use of weight‐bearing activities, bisphosphonates, and vitamin D and calcium supplementation in pediatric CP osteoporosis clinical practice guidelines remained the same.